RSV, Flu and COVID-19: Symptoms and When to See a Doctor

A respiratory illness is any illness that affects the respiratory tract — including the lungs, lower airways or upper airways (the “common cold”). Severe respiratory illnesses are most commonly caused by viruses such as RSV, flu and COVID-19.

Arkansas Children’s Pediatrics in Little Rock Pediatrician Laura Sisterhen, M.D., and Kaitlin Cockerell, M.D., a newborn hospitalist at Arkansas Children’s Hospital (ACH) in Little Rock, shared information parents and caregivers need to know going into respiratory illness season.  

“The Centers for Disease Control and Prevention (CDC) expect peak hospitalizations from flu, COVID-19 and RSV, like last season's peak, based on current data. Last season was exceptionally severe, especially for children. There's always a chance it could be higher depending on strain severity, vaccine rates in the community and potential new variants,” said Dr. Sisterhen, quality director of primary care at Arkansas Children's Hospital (ACH) in Little Rock and professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS). “Flu activity starts in October, peaks between December and February and can extend into the spring. The best time to get vaccinated is before flu begins to spread in your community, ideally in October.”  

How are viruses spread?  

Viruses are spread by secretions, such as a person coughing or sneezing on someone or out into the air. Saliva can also spread a virus, for example, if someone shares a drink or a kiss.  

“Someone must be in close contact with another person to spread it. It is not spread by just touching someone with the virus,” said Dr. Cockerell, also an assistant professor of pediatrics at UAMS.  

However, Dr. Cockerell noted that if a person with a virus sneezes or coughs, it can linger in the air or on surfaces for hours. 

Respiratory illnesses can be contracted throughout the year, but are most common during late fall and winter. 

“People typically spend more time indoors during the colder months, which can lead to the spread of germs,” Dr. Cockerell said. “Some viruses like the flu are thought to survive better in colder, drier conditions like winter.” 
 

Breaking it down: RSV, flu and COVID-19 

Medication cannot treat a virus. However, some medicines control symptoms caused by a virus, like coughing or fever, and can lessen the length of symptoms. For example, Tamiflu (for any age) or Xofluza (for ages 5 and up), if taken within the first 48 hours of flu symptoms, can help shorten flu symptoms. A person who starts the medication in that window may experience symptoms for five days instead of seven. 

Severe respiratory illnesses are most commonly caused by RSV, flu and COVID-19: 

• RSV, Respiratory Syncytial Virus. It causes common cold symptoms in older children and adults. Children under 2 and older adults are at risk for severe wheezing and respiratory distress, requiring oxygen and hospitalization. Trouble breathing is a hallmark symptom and dehydration can also occur. RSV is the most common cause of pneumonia and bronchiolitis in children under 1. 
• Flu, caused by the influenza virus. The most common strains are Influenza A and Influenza B. People can experience fever, muscle aches, congestion, coughing and vomiting. 
• COVID-19, caused by the SARS-CoV-2 virus. It causes various symptoms, including cough, congestion, a runny nose, fever, body aches, sore throat and loss of taste and smell. Most children who contract COVID-19 experience cold symptoms, but children with underlying conditions are most at risk. 

Children who contract a respiratory illness can see a doctor if they have the following symptoms: 

• Mild cough
• Runny nose 
• Sore throat 
• Fever at or less than 100.4 
• Mild fatigue 

If a child has a fever of 100.4 for more than 24 to 48 hours or their symptoms are not improving within five to seven days, parents should make an appointment with their pediatrician.. 

Emergency care is vital if a child has: 

• Trouble breathing
• Changes in alertness 
• Bluish lips or face 
• Persistent chest pain/pressure 
   

When to take your child to a doctor or the ER 

"The biggest reason you'd want to go to the emergency room is for a child's respiratory status. They need a more critical evaluation if they're visibly struggling to breathe or saying their chest hurts,” Dr. Cockerell said. 

Parents may notice fast or hard breathing when a child sleeps, indicating they're struggling to breathe. Lethargy is different from fatigue. Dr. Cockerell explained fatigue can look like a child with low energy who “just wants to lay around on the couch” but is still eating and drinking. 

“If a parent has difficulty waking their child up, it's lethargy. They need to go to the emergency room,” Dr. Cockerell said. 

Parents should immediately take a baby under six weeks with a fever to an emergency room because their immune systems are weak. 

Comfort at home and prevention 

There are many ways a parent can keep their child comfortable at home as they recuperate from a respiratory illness. 

• Lots of rest 
• Tylenol or Ibuprofen can be helpful for pain relief, even if a child does not have a fever. 
• Drink fluids to stay hydrated. If a child won’t drink, popsicles help with hydration. 

Several things can prevent or lessen a child’s chance of contracting a respiratory virus. There are vaccines available for children and adults for flu, COVID-19 and RSV. 

“A vaccine is a substance used to help the body develop an immune response to a certain disease,” Dr. Cockerell said. “Vaccines help your body fight off those diseases faster and better.” 

Dr. Sisterhen said children are at an increased risk for serious complications from the flu compared with healthy adults.  

“Kids are very efficient spreaders of the virus, and there is high exposure in schools and daycare, increasing the chance of repeated or severe infection. Young children may not have prior exposure to flu strains and have no immunity. They are also more likely to have conditions that make the flu more dangerous, such as asthma, neurologic or neurodevelopmental conditions,” Dr. Sisterhen said. “Children have smaller airways that can become obstructed more easily by inflammation or mucus. Infants cannot effectively clear secretions or cough forcefully. They have higher metabolic needs, meaning they use energy quickly and weaken faster than adults when sick. Each year, thousands of children are hospitalized with flu and, sadly, hundreds die from complications such as pneumonia, dehydration, encephalopathy (when there is an impact on brain function) or sepsis. Even previously healthy children can develop complications.” 

Medical experts recommend receiving the flu, COVID-19 and RSV vaccines early in the respiratory illness season. Providers can give all three vaccines at the same time. October is the best time for the flu shot, but a person can receive these vaccines at any time during respiratory illness season.  

“RSV season is also typically from October to April, and it is important for eligible infants to receive the RSV antibody once it’s available, or after birth if they are born during those months,” Dr. Cockerell said. “However, you can receive these vaccines anytime during the respiratory illness season. COVID-19 vaccines can be given at any time and would be beneficial before the fall and winter months.” 

• Flu vaccine: The 2025-2026 flu vaccines are all trivalent, meaning they have three strains of inactivated virus. The American Academy of Pediatrics (AAP) recommends the flu vaccine for those over 6 months old. 
• COVID-19 vaccine: The 2025-2026 COVID-19 vaccine is an updated formula that targets the “JN.1 lineage of the omicron variant,” according to the CDC. COVID-19 vaccines are updated to offer protection against current strains. The AAP recommends the COVID-19 vaccine for those over 6 months.   
• RSV vaccines: RSV vaccines are for adults over 75, adults 50 to 74 who are immunocompromised and pregnant women. The AAP recommends an infant RSV antibody for all children less than 8 months if their mother did not receive the vaccine in pregnancy, and for children 8-19 months with certain underlying conditions. 

“RSV has long been a leading cause of illness, hospitalization and infant death. Thousands of children are hospitalized each year for RSV. Pediatricians and families of those affected know all too well the stress when a baby has RSV,” Dr. Cockerell said. “There is no treatment for RSV, but we support children through it with oxygen, fluids, etc., until they get better. That’s why the vaccines and antibody therapy are so vital. We can now decrease the likelihood of catching RSV and ending up with severe illness.” 

Every relative in close contact with children younger than 6 months should ensure their vaccines are current. Other tips include: 

• Good hand hygiene, like scrubbing hands for at least 20 seconds. Children can sing or hum “Happy Birthday” twice to remember how long it takes to wash their hands. 
• Cough into their elbow instead of their hand. 
• Wear a mask in crowded public places. 
• If one child has a virus in the home and another is healthy, using Lysol in their sitting areas and hand-washing can limit the spread. 
• Do not allow contact between sick relatives and infants. Relatives should wash their hands and avoid touching the baby's face. 

"It's up to the parents and their discretion, but it's a good conversation to have with your family members. Ask them if they're coughing, have a runny nose or any respiratory illness symptoms,” Dr. Cockerell said. 

Where to find vaccines, treatment 

Arkansas Children’s Pediatrics provides COVID-19, flu vaccines and other immunizations across the state. ACH and Arkansas Children’s Northwest (ACNW) in Springdale deliver high-quality care in the emergency departments. 

Pediatric services are available at the following: 

• Arkansas Children’s Pediatrics in Little Rock 
• ACNW Primary Care Clinic
• ACH Southwest Little Rock Clinic 
• ACH Pine Bluff Clinic 
• ACH After-Hours Clinic
• Harvey Pediatrics, Operated by Arkansas Children's 

 

This article was written by the Arkansas Children’s content team and medically reviewed by Matthew Kelly, M.D., Laura Sisterhen, M.D., and Kaitlin Cockerell, M.D. 

Photo: A patient is examined at Harvey Pediatrics, Operated by Arkansas Children’s, in Rogers.