Kids and colds in the age of COVID-19

In ordinary times, kids with colds are a dime a dozen and rarely cause for concern. However, with COVID-19 still spreading, those tiny, runny noses have parents and pediatricians on high alert.

“We’re seeing an increase in colds right now,” says Dr. Lisa Eichberger, a board-certified pediatrician with Sharp Rees-Stealy. “And soon, we will add flu and RSV cases to that list. Considering the crossover in symptoms among colds, flu, RSV and COVID-19, parents are confused and worried. And as medical professionals, we’re being extra vigilant in our screenings.”

What to do if a child is sick
In general, kids who get COVID-19 have few and mostly mild symptoms, which can include cough, runny nose, nasal congestion, sore throat, swollen glands, fatigue, lack of appetite and fever. These symptoms are also common with colds, flu and RSV, which is why pediatricians are stressing the importance of ruling out COVID-19.

For starters, COVID-19 can pose higher health risks to both kids and anyone they may infect. Secondly, co-infection — being infected with both COVID-19 and the flu — has been shown to have severe outcomes, adding to medical professionals’ pleas for community members to get their vaccines — flu, COVID-19 and RSV, if applicable.

For a child with any cold-like symptoms, Dr. Eichberger suggests isolating them immediately and reaching out to their doctor for next steps. If COVID-19 is a consideration, they will likely recommend either:

1. Scheduling the child for a COVID-19 test or testing the child at home

2. Keeping the child isolated while symptoms continue

“There are a few considerations we make when deciding the best course of action,” Dr. Eichberger says. “What are the symptoms? Has the child been exposed to COVID-19? Whatever the choice, what we do know is that ruling out COVID-19 is a priority.

When the COVID-19 test is negative
A negative COVID test is cause for relief, but Dr. Eichberger warns parents to not let their guard down. Depending on the number of factors, including when during infection the test was taken, the test could bring back a false negative result. For this reason, Dr. Eichberger, recommends continued isolation while symptoms persist and until the child is fever-free for no less than 24 hours and without the use of fever-reducing medication.

A true negative diagnosis rules out COVID-19, but symptoms still indicate an illness. To treat COVID-19, a cold, flu or RSV, Dr. Eichberger recommends:

• A cool mist humidifier

• A nasal aspirator or saline nose drops

• For kids less than 6 months old: acetaminophen to treat aches, pain or fever

• For kids 6 months or older: acetaminophen or ibuprofen to treat aches, pains or fever

• For kids 1 year or older: a spoonful of honey in warm water, with a splash of lemon

• Plenty of rest and fluids

When the COVID-19 test is positive
A positive COVID test can be concerning, but Dr. Eichberger reassures parents it’s not cause for panic. “Data shows us that most kids recover quickly and easily from COVID-19,” she says. “Yes, we need to watch out for development of severe respiratory symptoms that would warrant hospital care, or multisystem inflammatory syndrome (MIS-C), a condition brought on by COVID that could impact kids. But this is very rare, and the incidence of MIS-C is currently very low.”

For the most part, Dr. Eichberger says, it’s most important to keep kids comfortable and make sure they don’t spread the virus to older, more at-risk friends, family members, day care providers and teachers.

The treatment plan for a child with COVID-19 is similar to treating the flu. But parents should seek emergency care if their child has any of the following:

• Rapid or labored breathing or a sensation of shortness of breath

• Fatigue

• Dehydration

• Fever lasting more than five days

• Altered mental status

• Unexplained bruising or bleeding

When to send kids back to school or other activities
Kids, in general, tend to bounce back from illness better than adults do. But in the age of COVID-19, when those infected can be asymptomatic, and testing can bring false negatives, parents need to be extra careful when sending their child back to a school or community environment.

To help parents, the California Department of Public Health offers the following advice when faced with a child who has COVID-19:

• Have the child isolate for at least 5 days counting from the day they began feeling sick. (Day 0 is the day they began feeling sick; Day 1 is the next day.)

• If they have no symptoms, then they should isolate for 5 full days after the day they tested positive for COVID. (Day 0 is the day they took their positive test; Day 1 is the day after.)

• They may end isolation after Day 5 if they have no symptoms, or their symptoms are mild and getting better, and they have not had a fever for 24 hours without taking medicine that lowers fevers.

• Consider having them wear a mask around others through Day 10 unless they have two negative at-home tests at least a day apart without a positive test in between.

• After they have ended isolation, if their symptoms come back or get worse, use an at-home test to test again. If they test positive, restart their isolation at Day 0.

“Flu season is coming, and so are big holidays that traditionally bring many people together,” Dr. Eichberger says. “Let’s keep cases down by following the precautions set in place to keep us safe.”

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