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Cold, Flu or COVID? How to Know and Ways to Treat

Typically during this season pediatricians see a lot of respiratory infections. This year it’s more important than ever to seek medical care and testing to distinguish COVID-19 from other types of viral infections. Joe Perno, M.D., vice president of Medical Affairs and Chief Medical Officer at Johns Hopkins All Children’s Hospital, explains what parents need to know about the common cold and viral respiratory infections.

How can you tell the difference between a cold from a sinus infection? What about COVID-19 and other viral infections?

Common Cold vs. Sinus infections

Most colds last five to seven days and symptoms can include runny nose, nasal congestion, cough and occasionally fever. It is caused by various viruses that affect the upper respiratory tract. Bacterial sinus infection is more likely than a cold or the flu to cause headache, sinus pressure and more than 10 days of nasal congestion or runny nose.

COVID-19 vs. Viral Infections

It is helpful to review if your child has had any COVID exposures. Loss of smell or taste is very suggestive of COVID-19, but like many other respiratory viral infections, other symptoms include sore throat, cough, nasal congestion, headache and/or fever. Anyone with respiratory symptoms this season should contact their provider to see if COVID-19 testing is warranted.

Why don’t we use antibiotics for a cold?

Antibiotics are only effective against bacterial infections and have no effect against viruses or colds. Giving antibiotics for a cold can be harmful because of side effects of the antibiotic treatment and due to antibiotic resistance that could form in bacteria exposed to antibiotic treatment when not treating a bacterial infection.

Why shouldn’t over-the-counter cough and cold medication be used in children?

Although there are many products marketed to children to combat cold symptoms, these medications are generally not effective in treating the symptoms of a cold and young children can sometimes develop dangerous side effects, including accidental overdoses, extreme drowsiness and increased heart rates. These are not recommended for children under the age of 8 years.

How can parents treat children with colds?

  • In young children, use a bulb syringe and saline drops to clear the nasal passages
  • Place a cool mist humidifier to help with cough and congestion
  • For children older than 1 year of age, use honey as a cough suppressant
  • Treat fevers with acetaminophen or ibuprofen to make the child more comfortable
  • Encourage plenty of liquids to avoid dehydration

How can we prevent the spread of illness?

Encourage children to frequently wash their hands when they have a cold and cover their nose and mouth when they sneeze by coughing into their elbow. Keep ill children isolated from others as much as possible when they have cold symptoms, especially if it may be COVID-19. Contact your child’s provider to discuss symptoms and whether testing is needed for COVID-19, flu, RSV or other viral infections.

For more pediatric healthcare information, visit

About the Author: Dr. Joe Perno is the vice president of medical affairs at Johns Hopkins All Children’s Hospital. He joined the hospital staff in 2003. Dr. Perno also maintains clinical time in the Emergency Department, where he started as an attending physician in 2003 and served as assistant medical director from 2005 through 2015. He has chaired the hospital’s Medicine Quality of Care Committee, and in 2009 he was named vice chairman of the Department of Pediatric Medicine. Dr. Perno also has been a key member of several system innovation and quality improvement efforts and served as chief of the medical staff in 2016. Dr. Perno earned his medical degree from St. George’s University in West Indies, Grenada. He completed a pediatric residency from Rutgers Robert Wood Johnson Medical School in Piscataway, New Jersey, followed by a fellowship in pediatric emergency medicine from Primary Children’s Medical Center in Salt Lake City, Utah.

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