Does Your Child Have a Cold or COVID-19?

Symptoms like fatigue, fever, and runny nose are unpleasant at the best of times. But right now, with the coronavirus pandemic still raging—and fueled by the highly transmissible Delta variant—these symptoms can cause a lot more worry and spur more consequences. Are you wondering, "Does my child have a cold or COVID-19?" Keep reading to learn how to tell the difference.

Children get colds when a virus (such as a rhinovirus) enters the body through the mouth, nose, or eyes. Symptoms appear within a few days, and the virus will replicate until your immune system or medication fights it off. Symptoms of a common cold in children can include:

COVID-19 is a respiratory illness that spreads when an infected individual talks, coughs, sneezes, or breaths. Airborne transmission is also possible. Symptoms generally appear within 2 to 14 days of exposure to the virus, according to the Centers for Disease Control and Prevention (CDC), and they include:

Many of these overlap with colds and the flu, the CDC acknowledges. This is particularly true for children, who are more likely to have mild or asymptomatic cases of COVID-19, and who get colds frequently.

It's also important to note that the coronavirus presents differently for everyone. Some children have no symptoms whatsoever, others have mild illnesses that resemble colds or flus, and few suffer serious complications that result in hospitalization or death (though this remains rare).

"It can be difficult to tell the difference between COVID-19 and the common cold in children," says Zachary Hoy, M.D., pediatric infectious disease specialist at Nashville Pediatric Infectious Disease. "If you think your child has symptoms that could be related to COVID-19, they should be evaluated by their pediatrician and possibly get COVID-19 testing."

Indeed, the CDC states that the best way to differentiate between COVID-19 and the flu (as well as other illnesses like colds) is to get tested. A PCR test is a highly sensitive test used for identifying the presence of COVID-19 in a person. A nasal swab is processed and analyzed for the presence of viral DNA, which can be detected in very low amounts. This test must be processed by a lab, using specialized equipment, and the turnaround time can vary from several hours to several days, depending on local testing capacity.

You can also take an antigen test, which can be used at "point of care" locations, in a doctor's office, or at home. Antigen tests are less sensitive than PCR tests, so they might not return a positive result if the person has very low levels of the virus. But they're also less likely to return a "false positive" result (meaning the person isn't actually infected) and can identify infectious people who could transmit COVID-19 to others. Michael Mina, M.D., Ph.D, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health, has described how antigen tests can be useful in making sure people don't isolate when they don't need to. 

Also don't rule out the fact that your child could have a common cold and COVID-19 simultaneously. "It's common to have co-infections with COVID-19," says Dr. Hoy. "We have seen a lot of other common cold viruses—rhinovirus, enterovirus, and respiratory syncytial virus (RSV)—with children that are positive with COVID-19. Sometimes it can be difficult to tell which symptoms are from COVID-19 and which are from other co-infections"—which is why testing is so important.

Many schools or workplaces have encouraged, or required, people to stay home if they have any symptoms of COVID-19, which often overlap with symptoms of a common cold. Some school districts will require a negative test result to return to school instead of waiting for a set period after symptoms resolve. Check with your local school district or child care provider to see whether a PCR test is required or if an antigen test will be accepted. Antigen tests, like the BinaxNOW by Abbott, are available over the counter.

Also take care to monitor your child's symptoms, as they can also stem from other illnesses like RSV. "It's possible other respiratory infection tests or a chest X-ray may be done at the same time if symptoms are more severe," says Dr. Hoy.