Cold vs Flu in Children: How to Tell the Difference and When to Seek Care
Colds and flu are both respiratory illnesses in children, but they are caused by different viruses and can affect kids very differently. Cold symptoms usually develop gradually and include a runny nose, mild cough, and little or no fever. Flu symptoms tend to start suddenly and are more severe, with high fever, body aches, fatigue, and headaches. Knowing the difference helps parents decide how to care for their child and when to seek medical attention. Immediate care is needed for babies with any fever, children with breathing difficulty, dehydration, or very high fevers.
It often starts the same way. Your child wakes up congested or tired, and you wonder if it is just a cold or something more serious. Colds and flu can look similar at first, especially in young children who cannot clearly explain how they feel.
Understanding the difference between cold and flu helps parents respond with the right care, monitor symptoms appropriately, and know when medical support is needed. This guide explains how symptoms differ, how illness may look at different ages, and when to call a healthcare provider.
Nest Health offers in-home and virtual pediatric care, making it easier to get guidance for sick children without exposing them to other illnesses in waiting rooms.
If you’ve been contacted by Nest or your health plan or think your family may be eligible, call 866 222 NEST or 866 222 6378.
Understanding Colds and Flu: What’s Really Different?
Colds and flu are both respiratory infections, but they are caused by different viruses.
Colds are most often caused by rhinoviruses. There are hundreds of types, which is why children can get many colds each year. Most children experience six to eight colds annually.
Flu is caused by influenza viruses, usually types A or B. Flu is less common than colds but tends to be more severe and carries a higher risk of complications.
Both illnesses spread through respiratory droplets and by touching contaminated surfaces. Knowing which illness your child likely has matters because flu may require closer monitoring and, in some cases, prescription antiviral treatment.
Learn more about pediatric care at Nest Health: https://www.nesthealth.com/services/pediatric-care
Key Symptom Differences: Cold vs Flu in Children
How Cold Symptoms Start and Progress
Cold symptoms usually develop slowly over one to three days.
Common early signs include a scratchy throat, sneezing, and a runny or stuffy nose. Congestion often worsens before improving, and a mild cough may develop.
Fever is uncommon or low grade, usually under 101°F if present at all. Children often remain playful, though they may tire more easily.
Colds typically last seven to ten days. Cough can linger for two to three weeks. Symptoms usually peak around days three to five and then improve gradually.
How Flu Symptoms Start and Progress
Flu symptoms tend to appear suddenly and feel intense.
A child may seem well in the morning and very ill by the afternoon. Fever is usually high, often between 102°F and 104°F, and may last three to five days.
Body aches, chills, and headaches are common. Children often describe hurting all over. Fatigue can be severe, with little interest in play or food. Cough is often dry, harsh, and present early.
Acute flu symptoms usually last five to seven days, though fatigue may persist for several weeks. The first three to four days are typically the most severe.
Side-by-Side Symptom Comparison Chart
| Symptom | Cold | Flu |
|---|---|---|
| Onset | Gradual (1–3 days) | Sudden (hours) |
| Fever | Rare/low-grade | High (102–104°F) |
| Body aches | Mild or absent | Severe, common |
| Fatigue | Mild | Severe, exhausting |
| Headache | Rare | Common, intense |
| Cough | Mild, develops slowly | Severe, immediate |
| Stuffy nose | Very common | Sometimes present |
| Sore throat | Common early sign | Sometimes present |
| Duration | 7–10 days | 5–7 days (acute) |
Age Specific Differences: Babies, Toddlers, and Older Children
Cold and Flu in Babies 0 to 12 Months
Babies cannot describe symptoms, so behavior changes are key.
Cold symptoms may include fussiness, feeding difficulty due to congestion, and disrupted sleep. Fever is often absent or mild.
Flu in babies may cause sudden high fever, extreme fussiness or lethargy, poor feeding, fewer wet diapers, and rapid or labored breathing.
Any fever in a baby under three months requires immediate medical evaluation. Babies under six months cannot receive the flu vaccine, making household prevention especially important.
Cold and Flu for Toddlers 1 to 3 Years
Toddlers may communicate discomfort through behavior.
Cold symptoms often include a runny nose, reduced appetite, mild crankiness, and some interest in play. Ear pulling may occur due to congestion.
Flu symptoms may include sudden refusal to eat or drink, constant need to be held, excessive sleepiness, and crying that is hard to soothe. Rapid fever spikes increase the risk of febrile seizures in this age group.
Cold and Flu in Preschool and School Age Children 4 Years and Older
Older children can usually describe symptoms clearly.
With a cold, children may complain of a stuffy nose or scratchy throat and still want to play, though they tire more quickly.
With flu, children often describe severe headache, chills, body aches, and feeling very sick overall. They may have no interest in activities and may also experience stomach pain or nausea.
When It’s Not Just a Cold: Recognizing Flu Complications
Flu carries a higher risk of complications, especially in children under five or those with chronic health conditions.
Pneumonia Warning Signs
Watch for a cough that worsens after initial improvement, rapid or difficult breathing, chest pain, bluish lips or face, or fever that returns after breaking.
Any breathing difficulty requires immediate medical attention.
Dehydration Red Flags
Signs include fewer wet diapers, little or no urination, dry mouth, no tears when crying, sunken eyes, or extreme sleepiness.
Contact a healthcare provider the same day if dehydration is suspected.
Ear Infections and Sinus Infections
Secondary bacterial infections can follow both colds and flu.
Ear infection signs include ear pain, ear pulling, or fever that returns. Sinus infection signs include facial pain or thick nasal discharge lasting longer than ten days. Antibiotics may be needed for bacterial infections.
Treatment Approaches: What Works for Colds vs Flu
Treating Colds in Children
Colds are viral, so antibiotics do not help.
Treatment focuses on comfort and supportive care:
Adequate rest
Fluids such as water, warm liquids, or popsicles
Cool mist humidifier for congestion
Saline drops for nasal congestion
Head elevation during sleep (this is not advised for children under 1 year of age who should not have anything else in the crib with them)
Over the counter medicines should be used cautiously and only according to age and provider guidance.
Treating Flu in Children
Contact a healthcare provider early if flu is suspected, especially when there is known exposure..
Antiviral medications may shorten illness and reduce complications, especially when started within forty eight hours. They are particularly important for young children and those with chronic conditions.
Supportive care includes rest, hydration, fever management, and close monitoring for complications.
What NOT to Do for Either Illness
Never give aspirin to children with viral illnesses
Do not force food, but encourage fluids
Avoid sending sick children to school or daycare
Do not request antibiotics for viral infections
Avoid cough and cold medicines in young children without provider guidance
When to Call the Doctor: Different Thresholds for Colds and Flu
Emergency Care Needed Immediately Call 911
Trouble breathing or gasping
Blue lips or face
Severe dehydration
Extreme confusion or difficulty waking
Seizure lasting more than five minutes
Chest pain
Call Doctor Same Day: Flu Concerns
Any flu symptoms in babies under six months
Fever above 103°F lasting more than three days
Symptoms that worsen after initial improvement
Persistent vomiting or inability to keep fluids down
Child has a high risk medical condition
Call Doctor Same Day: Cold Concerns
Any fever in a baby under three months
Symptoms lasting more than ten days
Severe ear pain or drainage
Persistent cough disrupting sleep
Wheezing or breathing difficulty
Monitor at Home but Call With Any Concerns
Colds with mild symptoms, low grade fever, and steady improvement can often be managed at home. Flu can also be monitored at home if diagnosed, improving as expected, and hydration is maintained.
Trust your instincts. If something does not feel right, call your healthcare provider.
How Nest Health Supports Families with Sick Children
Colds and flu can look similar, but differences in symptom timing and severity matter. Nest Health helps families navigate these decisions with trusted pediatric care.
Our care teams provide personalized guidance, medication support, and fever management through in-home and virtual visits. Care is covered by select Medicaid health plans.
Learn more about pediatric care at: https://www.nesthealth.com/services/pediatric-care
If you’ve been contacted by Nest or your health plan or think your family may be eligible, call 866 222 NEST or 866 222 6378 to get started with whole family care.
