RSV and COVID-19: FAQs on How to Recognize Them and What to Do

​​​​​Children are exposed to many viruses as part of everyday life, whether at school, daycare or when playing sports. Sometimes they result in disease, and they can range from rhinovirus to COVID-19 to respiratory syncytial virus (RSV).

Both COVID-19 and RSV can be serious illnesses that should be of concern to parents. Each can cause a spectrum of disease that is sometimes mild and sometimes severe. RSV causes many hospitalizations in children (50,000-80,000 each year according to the CDC), and most hospitalizations from COVID-19 in children are in those under 5 years of age.

How do you know if your child has RSV or COVID-19?

It can be difficult to tell the difference between RSV and COVID-19, and it would be a mistake for parents to think that just because their child is exhibiting RSV symptoms, that they don't have COVID-19, or vice versa. It is safest to contact your pediatrician at the onset of symptoms in your child.

The important thing for parents is to keep track of the timing and type of symptoms your child exhibits. This will help your pediatrician make an accurate diagnosis and suggestions for treatment and testing.

Early COVID-19 symptoms vary and can include:

• Fever
• Chills
• Shortness of breath
• Fatigue
• Body aches
• Loss of taste or smell
• Cough
• Sore throat
• Vomiting or diarrhea
  

There may also be congestion or a runny nose, which is similar to RSV.

In contrast, early RSV symptoms tend to be consistent amongst children and include:

• Runny nose/nasal congestion
• Cough
• Decreased appetite
• Fever
• Wheezing/difficulty breathing
  

It is important to note that a child can have both RSV and COVID-19 at the same time, or a child can be sick with one illness and develop the other.

What are the ages of children affected by RSV and COVID-19?

Although children of all ages can be affected by both RSV and COVID-19, RSV tends to be more severe in younger children, particularly those under 12 months. 

How severe are the symptoms of RSV and COVID-19 in children?

RSV tends to become worse over the first five days of the illness. For some children, it is only a mild cold. For other children, it can result in high fevers or difficulty breathing, which may require hospitalization for respiratory support. Parents should call their doctor if their child has a whistling or wheezing noise when they breathe, is breathing fast or has a high fever. Also, for infants, contact the doctor if the baby refuses to feed.

COVID-19 frequently mutates, and the severity can vary. Sometimes it is mild, and other times it can cause more severe disease. With more recent variants, it has tended to cause fever or a bad cough early in the illness, but if it persists, can become worse. Some cases require hospitalization. As with RSV, parents should contact their doctor if their child has a high fever, difficulty breathing or is not feeding well.

How can you protect your children against RSV and COVID-19?

Handwashing and disinfecting frequently touched surfaces are good places to start. If a child is at high risk, parents may consider using a mask to help shield their nose and mouth if they will be in close contact with someone with COVID-19. There are vaccines available to help protect against COVID-19. Also, recently approved in the late summer of 2023, a monoclonal antibody will soon be available to help protect children under 8 months of age and those at high risk through a second RSV season up to age 2 years. There is currently an RSV vaccine for adults over age 60 years and vaccinating members of the family against these diseases can help protect children as well. Parents should talk to their doctor about these recently approved protections to learn when they will be available for their child.