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2023 Jan

Tripledemic Tips

What to do when your child has the flu, RSV, or Covid

It’s been a busy cold and flu season in pediatrics. Not only are there the ordinary strains of the cold virus circulating, but clinics are seeing what is being called a “tripledemic.” This is not a medical term but refers to a set of three viral illnesses, namely influenza (the flu), RSV (respiratory syncytial virus), and COVID-19.

The fact that we are seeing all three occur together has challenged the healthcare system, affected daycare centers, caused loss of work time, and worried parents. We may be seeing a rebound of illnesses which were suppressed during the past few years with Covid restrictions. These illnesses are leading into secondary infections (ear infections, sinus infections, and pneumonias), which warrant antibiotics, thus there have been shortages of antibiotics.


Influenza, better known as “the flu,” presents with fever, chills, runny nose, cough, and body aches. It spreads through the air in cough-droplets. Flu season usually strikes between October through May; however, this has been an earlier than usual flu season.

Since flu is viral, antibiotics will not be effective. There are anti-viral medications which may be given within 48 hours of the onset of flu symptoms by prescription only. See your pediatric healthcare provider if your child is ill. Flu generally lasts 7-10 days. See your pediatric healthcare provider if fever persists longer than 3 days or if the illness is worsening or persisting longer than the expected 7-10 days.

Kids younger than 5 years have a higher risk of complications from the flu. Complications may include pneumonia, ear infections, and sinus infections which would warrant antibiotics. Children with chronic illnesses, asthma, or breathing issues are at a higher risk of complications.

Prevention is the best strategy for flu. Flu shots are available for children ages 6 month and older. It is not too late to get your child a flu shot. Flu shots should be given when the child is well. Although the effectiveness of the flu shot can vary from year to year, it reduces the risk of getting influenza and reduces the severity of the symptoms.


Respiratory syncytial (sin-SISH-ul) virus causes cold-like symptoms and is very contagious. It is a common virus that most children have had before age two and is spread from person-to-person through air droplets. The symptoms include a runny nose, decreased appetite, cough, and a fever is possible. Some children will wheeze as RSV is the most common cause of bronchiolitis and pneumonia in infants.

As this is a viral illness, most cases resolve without treatment, but some children (pre-term infants and young infants) are at higher risk of respiratory complications or secondary bacterial infections. If you have concerns about your child, see your pediatric healthcare provider.


This is a viral illness which causes a large range of symptoms (or none at all). These may include fever, chills, cough, shortness of breath, fatigue, body aches, headache, loss of taste and/or smell, sore throat, nasal congestion, runny nose, nausea, vomiting, and diarrhea. Isolation, masking, and handwashing are all methods to decrease the spread of disease. As with the other viral illnesses, antibiotics are not effective unless there is a secondary bacterial infection present. The CDC (Centers for Disease Control and Prevention) recommends that everyone aged 6 months and older get vaccinated against COVID-19, stating that the benefits of vaccination outweigh any potential (rare) risks.

What can you do?

Teach your children good handwashing skills. Keep your child home when they are ill to decrease the spread of disease. Avoid contact with ill people. Cover coughs and sneezes. Consider masking in high-risk areas (crowds/indoors). There are vaccines to protect against influenza and COVID-19.

What if my child is sick?

Although this cold and flu season feels challenging, the immune system is designed to effectively fight off illness. Most viral illnesses last 7-10 days. Provide adequate fluids. Comfort measures such as humidification (cool mist) can be helpful. Nasal saline spray and bulb syringe may help infants breathe, feed, and sleep easier. Children’s Tylenol/acetaminophen (dosed per weight) can provide comfort for fever or pain. Allow time for rest at home. Keeping children home when they are sick helps to decrease the spread of disease.

Watch children closely and seek medical care if you have concerns about your child’s health. There are tests for influenza, RSV, and COVID-19. These are nasal swabs which may be rapid (back in 10 minutes) or sent to the lab (back in a day or two). Call your pediatric healthcare provider with questions or concerns. Dial 911 if your child has shortness of breath, difficulty breathing, or other emergent concerns.

If your child gets a secondary (bacterial) infection after the viral illness, such as an ear infection, she may need antibiotics. There have been some antibiotic shortages, so consider seeking the medication at another pharmacy, requesting a generic, or contacting your pediatric healthcare provider for a different antibiotic if you are unable to find the one prescribed.

For more information:


Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on Amazon.com.

Website: www.RaisingTodaysChild.com

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