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As we get further into winter, we get deeper into cold and flu season. Over the last few years, COVID has been added to the list of illnesses to watch out for. And there’s also a resurgence of respiratory syncytial virus (RSV) this year, too. Of course, you’ll want to discuss vaccinations for flu and COVID with your pediatrician. But when the sniffles start, how do you know which illness your kid has? And does it really matter?

Paying attention to symptoms may help you identify what your child has. Or not. “The symptoms are so similar, and there’s some overlap with all of these illnesses,” says David Cennimo, MD, FACP, associate professor of medicine and pediatrics in infectious disease, Rutgers New Jersey Medical School. “It’s very difficult to tell from symptoms alone, especially if your child is vaccinated, which modifies presentation of symptoms.”

In general, all of these illnesses may include runny nose, stuffy head, cough, fatigue, headache, sore throat, body aches and fever. “One indicator it’s the flu is that it comes on suddenly,” says Anat Feingold, MD, MPH, division head, pediatric infectious disease, Children’s Regional Hospital at Cooper University Health Care. “There’s usually also a high fever of above 101.5, and there also may be nausea, vomiting and diarrhea.” But it’s important to remember that everyone is different and symptoms vary from kid to kid.

RSV also has similar symptoms. “For most older children and adults, RSV presents as a bad head cold,” says Cennimo. “It usually involves a lot of runny nose and upper respiratory congestion. It’s also a significant source of wheezing.”

Here’s what you should know about colds, flu, COVID and RSV:

Encourage handwashing. It’s okay to repeat yourself to get your kids to wash their hands. Make sure they know to use soap, sing “Happy Birthday” twice through and do it at times such as before meals, after bathroom breaks and after nose blowing. “Handwashing is just as critical as ever,” says Feingold.

Keep sick kids home. If your child isn’t well, don’t send him or her to school or daycare, says Feingold. If you’re unsure about whether your child’s symptoms warrant staying home, call your pediatrician. That goes for parents, too; stay home if you’re sick.

Test when needed. If your child has an underlying chronic illness such as asthma or kidney disease, you should test because they are at greater risk of severe illness or complications, says Cennimo. It’s also recommended if your child is around very young children, older adults or people who are immunocompromised in order to protect these high-risk individuals.

Manage the symptoms. You can help them feel better by providing supportive care, says Cennimo. Make sure kids get plenty of rest and fluids, give acetaminophen to manage fever and body aches and use saline nasal spray to loosen and thin secretions to blow them out. Antihistamines can help with drippiness, but don’t use cough medications or decongestants, which aren’t effective. You also can offer kids who are older than one year a mix of hot tea and honey or a spoonful of honey, which has antibacterial properties, to soothe a tickle or sore throat.

Watch for more serious symptoms. If your child seems to be getting worse, is wheezing or is struggling to catch their breath, call your pediatrician. If you’re fairly sure it’s the flu—perhaps it’s been going around at school—your child’s doctor may prescribe an antiviral medication, as long as it’s within the first 48 hours, says Feingold.

Don’t forget about all the other bugs out there. While we’re focused on colds, flu and COVID, there are plenty of other bugs making the rounds. Enterovirus, which also causes a mild cold-like illness, is also being seen frequently this season. RSV is usually mild but can cause inflammation of the small airways of the lungs, so it’s especially dangerous to the very young and older adults. It’s definitely on the upswing this year, says Feingold. For infants, young kids and people with lung disease, RSV can be relentless and lead to severe viral pneumonia and significant respiratory distress. “For this reason, prophylaxis is recommended for some very high-risk infants who were born prematurely, to prevent or reduce infection,” says Cennimo. The medication is palivizumab, a monoclonal antibody injection given monthly during RSV season.

Most seasonal illnesses last a week or two at most for younger kids. But if your child isn’t getting better beyond that or seems to have gotten better then suddenly worse, call your pediatrician, says Cennimo. You know your kids best, so trust your gut.

— Arrica Elin SanSone is a New York-based health and lifestyle writer.

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