How to Handle the Most Common Childhood Viruses

By Christina Elston

Kids get sick. It’s a fact of life, but that doesn’t make it any easier on us parents. Our battle to make it better begins with the first cough, sniffle or sneeze. And the enemy? A nasty little thing called a virus, the cause of most childhood illnesses.

What Viruses Do

Viruses are not bacteria, the other type of “germ” that makes us sick. Bacteria are complete organisms that can exist on their own and are big enough to be seen through a microscope. Viruses are much smaller and need a host cell (like one of yours) to live.

Viruses and bacteria are both transmitted through contact with infected secretions from the body or contaminated hands or objects – but the two are treated quite differently.

“Antibiotics are effective against bacterial infections but not against viral infections,” explains Danielle Zerr, M.D., a pediatric infectious disease specialist at Children’s Hospital in Seattle. “There are a few antiviral medications available (for example, anti-influenza medications), but nothing available for the common cold.”

Still, knowledge is power. Here’s a guide to the most common virus-caused illnesses in childhood, and the kinds of treatment you can offer to give your child relief:


• Causes: respiratory syncytial virus (RSV), parainfluenza, influenza, adenovirus.

• Symptoms: Bronchiolitis, an inflammation of the small passages in the lungs (bronchioles), and bronchitis, an inflammation of the main passages in the lungs, cause cough, shortness of breath, and fever, and most often occur during fall and winter.

• Duration: One week.

• Possible Complications: “Bronchiolitis in young children is a relatively frequent cause of hospitalization,” says Donald Goldmann, M.D., senior associate in medicine at Children’s Hospital in Boston.

“It’s not necessarily just a nuisance. It can be severe.” Complications include secondary infections, such as pneumonia, and even respiratory failure.


• Causes: Varicella-zoster virus.

• Symptoms: Fever, headache and itchy, fluid-filled blisters that burst and form crusts. A vaccine is available, but those vaccinated can still get mild forms of the illness, and immunity wanes over time. “We’re still trying to figure out when, and if, boosters are necessary,” says Goldmann.

• Duration: Pox appear two to three days after other symptoms begin, and last about one week.

• Possible Complications: Pneumonia, hepatitis and encephalitis (an inflammation of the brain). Spike in fever, extreme pain from the lesions, or redness extending beyond the lesions could be a sign that they have become “super-infected” with strep, Goldmann says.


• Causes: More than 200 different viruses, including rhinovirus, RSV and adenovirus.

• Symptoms: Runny nose, congestion and cough, sore throat, irritability, swollen glands and loss of appetite.

• Duration: One week, with possible lingering symptoms for 14 days.

• Possible Complications: Bronchitis, pneumonia, ear infections, and sinusitis.


• Causes: Most commonly parainfluenza; RSV, adenovirus and others can also cause it.

• Symptoms: This infection causes swelling around the vocal chords, accompanied by a mild cold, a “barking” cough and labored breathing (called “stridor”). Jeffrey R. Starke, M.D., director of infection control at Texas Children’s Hospital in Houston, distinguishes stridor from wheezing: “Stridor is noisy breathing in,” he says, “while wheezing is noisy breathing out.”

• Duration: Usually three to seven days.

• Possible Complications: Respiratory distress or arrest. Doctors often give doses of steroid medication to help combat severe coughing. Humidity from a steamy shower can help mild cases, as can fresh, cold air.

Fifth Disease

• Causes: Parvovirus B19.

• Symptoms: The illness begins with a bright red rash on the cheeks, followed by a reddish, bumpy, itchy rash on the limbs.

• Duration: The rash generally lasts five days but can recur for several weeks.

• Possible Complications: Generally none, but Jeff Johnson, M.D., head of emergency department admissions at Children’s Hospital in Los Angeles, recommends a way to distinguish the illness from others that might be more serious: Press a clear drinking glass against the rash, and look through the glass at the skin. If the color drains out of the rash, and the skin whitens temporarily, it is a “blanching” rash and is likely Fifth disease. If the skin under the glass remains red, it is a “petechial” rash, and a sign that you should call the doctor. (This type of rash, also called “bleeding into the skin,” could be a sign of an autoimmune disorder such as lupus, a bleeding disorder, leukemia, or other serious medical condition.)

Hand, Foot & Mouth Disease

• Causes: Coxsackie virus.

• Symptoms: Ulcers in the mouth and a blistered rash on the hands and feet, plus fever, sore throat and headache.

• Duration: Five to seven days.

• Possible Complications: Dehydration, because children refuse fluids due to pain from swallowing. Johnson recommends treating mouth pain with ibuprofen.


• Causes: Viruses that infect the respiratory tract; influenza type A virus and influenza type B virus.

• Symptoms: A mild flu that lasts just a day or two is actually a cold. “Real flu is a nasty illness,” says Starke. It involves high fevers of 103º or 104º Fahrenheit, body aches and respiratory symptoms that keep kids in bed for thee or four days.

• Duration: Seven to 10 days.

• Possible Complications: Pneumonia, bronchitis, and sinus and ear infections. Flu can often be prevented through vaccination, which is recommended every year for children ages 6 months to 2 years, pregnant women, the elderly and those with chronic health problems.


• Causes: Epstein-Barr virus (EBV).

• Symptoms: Fatigue, headache, and a sore throat that gets progressively worse, often mimicking strep throat. Also fever, enlarged lymph nodes, enlarged liver and/or spleen.

• Duration: Two to four weeks.

• Possible Complications: Secondary bacterial infection of the throat. Because the liver or spleen are easily ruptured when they are enlarged, children with EBV should not participate in contact sports, and younger kids need to be watched carefully, Johnson notes.


• Causes: Human herpes virus 6.

• Symptoms: High fever, irritability and a red rash.

• Duration: Rash appears as the fever subsides, two to four days after the illness began. The rash lasts a few hours to about two days.

• Possible Complications: Because it causes high fever, young children with roseola need medical attention, Johnson says. The fever can cause febrile seizures and, in rare cases, encephalitis.


• Causes: A virus (of the same name).

• Symptoms: Diarrhea, upset stomach, fever and occasional vomiting.

• Duration: Three to 10 days.

• Possible Complications: In the United States, rotavirus is usually “just a nuisance diarrhea, often with fever,” Goldmann says. But dehydration is a possible complication.


• Causes: Enteroviruses.

• Symptoms: This inflammation of the lining of the brain causes fever, headache and stiff neck. Unlike bacterial meningitis, which is a serious illness requiring antibiotic treatment, viral meningitis is generally mild with no treatment required.

• Duration: Up to two weeks.

• Possible Complications: None with viral meningitis, but bacterial meningitis requires immediate hospital treatment because it can cause hearing loss, brain damage and loss of vision.

Viral Pneumonia

• Causes: RSV, influenza, adenovirus and several others.

• Symptoms: Pneumonia is an irritation and swelling of the lungs that causes cough, headache, shortness of breath, fever, fatigue and sore throat. The younger the child, the more likely it is to be serious.

“If a baby or small child develops rapid breathing during a cold, it could indicate pneumonia and is a signal to call your pediatrician immediately,” says Neil Schachter, M.D., medical director of the respiratory care department at Mt. Sinai Medical Center in New York City and author of The Good Doctor’s Guide to Colds & Flu (Collins, 2005).

• Duration: Mild cases should play themselves out in one to three weeks.

• Possible Complications: Complications in more serious cases can include respiratory, liver and heart failure. Bacterial pneumonia, a much more serious matter that requires treatment with antibiotics, can follow on the heals of a viral infection.

Christina Elston writes about child and family health issues. Read her blog Healthe



The Good Doctor’s Guide to Colds & Flu, by Neil Schachter, M.D., Collins, 2005.
Guide to Your Child’s Symptoms, American Academy of Pediatrics, 1997.
The 24-Hour Pediatrician, by Christina Elston, Three Rivers Press, 2002.

Treating Viral Infections

Because viral infections cannot be cured with antibiotics, doctors and parents can only do their best to relieve kids’ symptoms and let the infection run its course. In general, children who are sick need plenty of rest and lots of fluids. Hydration helps relieve stuffy noses and coughs by making secretions thinner; it also makes kids with a fever feel more comfortable.

Itchy rashes can be treated with over-the-counter calamine lotion or a lukewarm oatmeal bath. Fever in children older than 2 months can be treated with acetaminophen, and muscle aches and other pain can be treated with ibuprofen. Doctors warn against giving aspirin to children, because it has been associated with Reye’s syndrome, a potentially fatal complication causing brain and liver damage.


Use of other over-the-counter medications to relieve symptoms is a matter of parent and doctor preference, says Starke.


“I’m not a big fan of cough and cold medicines, especially in kids under 2 years of age,” says Johnson, adding that coughs actually protect a person’s airway by keeping mucus from getting down further into the lungs.


Schachter recommends against antihistamines and decongestants for kids under age 6, but says they can provide relief in older children. “To help a child under 6 to breathe, you can suction out the mucus with a nasal bulb or put three drops of saline nasal wash in each nostril,” he says.