Is it a Cold or is it the Flu?

cold-or-flu1The winter flu season is reaching its peak, and more than 40 states now report widespread activity, but how do you tell the difference between a common cruddy cold and the real thing? This may be THE most common question kid docs get during the winter season, followed closely by …  “can I still send her to school?”

Of course, if the family all got the flu shot this season there’s less guesswork involved. This year’s formula is very effective against the year’s most common strain, H1N1

(Please note: the following discussion refers to the respiratory flu common during the winter months, not the gastrointestinal ‘flu’ that causes eruptions from both ends and is a whole different animal).

The flu and the common cold are both caused by viruses, but viruses in different families (influenza and rhinovirus respectively, for those who like the details). For this reason … and listen up, this is important … antibiotics will not help in either case. Viral illnesses laugh at antibiotics. Especially the pink bubble gum kind. 

But there are some important differences in symptoms, treatment, and potential complications that will help you tell these players apart.


The flu often comes on fast and furious. If kiddo bounces off to school in the morning feeling fine, and crawls off the bus in the afternoon looking like h*ll and feeling worse, chances are it’s the flu. We call it the “hit by a truck” sign. A cold is somewhat kinder and gentler in onset. A runny nose, a scratchy throat, a little cough — no big deal.

Flu comes with higher fever — often 101.5 F or higher. Temp with a cold is usually low-grade.

Extreme fatigue with body aches means flu (again, the hit by a truck sign). A cold has more local symptoms that stay at chest level and up.

Both colds and flu can come with sore throat, the flu variety may be worse.

Kiddos with a cold will likely be eating, drinking and playing, in spite of the greenish yellow gunk pouring out of their nose. The flu — not so much. They feel lousy and you know it.


If you suspect the flu, it pays to get in to medical care ASAP. New antiviral medications (not to be confused with antibiotics) are effective and, in severe cases, can shorten the duration of symptoms and prevent complications. Let your doc decide if they’re indicated. They work best if started within 24 hours of onset of symptoms.

You still may need symptomatic relief for fever and discomfort. Always follow appropriate dosage recommendations for acetaminophen (Tylenol) and ibuprofen (Advil, Motrin, etc,). Both can be dangerous if you overdo it.

Remember, OTC cough and cold remedies are NOT safe for children under 4. And they don’t work, anyway.

Don’t forget comfort measures and home remedies. Fluids, warm or cold, really do make a difference. Whatever kiddo will drink is fine, though sugary juices are best diluted with water — as much as you can get away with. Chicken soup is good medicine, and we have the research to prove it. A big dose of TLC will always make kiddo feel better, so pull out those board games and indulge in some quality time.

And here’s a tip that we swear works, though we don’t know why: Place a dab of peppermint essential oil or Vicks-Vaporub on the sole of the foot before bedtime and cover with cozy socks. It will reduce nighttime coughing so your little one can snooze through … no kidding!


Let’s hope this doesn’t happen, but the flu has potential for some nasty complications, from pneumonia to secondary infections and much worse. Every year we hear about deaths from flu — mostly in the very old and the very young. So pay close attention to that mommy radar and get back to your doc if you’re worried. This year’s strain has cause an unusual number of death in healthy and fit young adults, so don’t take chances.

Please don’t send kiddo to school with the flu. He needs rest to get healthy, and it’s grossly unfair to all the other families that could get sick. The influenza virus spreads like wildfire, and think how you’d feel if the child at the next desk laid your family low for days or weeks.

Colds can get complicated too, but the worst you’re looking at is probably an inner ear infection or some yucky sinuses. If the symptoms aren’t improving rapidly by day 14 it’s worth checking out — there may be a pink antibiotic in your future, after all.

The cold virus becomes far less contagious after 3 or 4 days of symptoms, so as far as school’s concerned, let your conscience be you guide.

So that’s the flu v. cold 4-1-1. Rachel’s niece just called. She has 2-year-old twins who got the flu vaccine back in November. Turns out, they just have a snotty cold.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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