If you’re deep into cold and flu season and feel like you can’t catch a break, you're not alone. 

While illness is always something that plagues parents of small children during the winter months,  it seems this year is particularly challenging — and making more headlines.  Earlier this winter, we were warned of the earlier and larger-than-normal surge of RSV, and now, you’ve likely heard of the latest concern: The Virus Triple Threat. 
What is this triple threat exactly? And, what should parents keep in mind? We talked to Dr. Chase Parsons, Pediatric Hospitalist and the expert that leads our health and safety classes, for all the details. Check out his answers below:  
What is the “virus triple threat” we keep hearing about? 
The virus triple threat this winter describes the combination of RSV (respiratory syncytial virus), influenza (the flu), and COVID-19 — all of which are infecting parents and children at high rates this winter season.  
Of course, prior to COVID-19, we had plenty of cases of RSV and the flu, but seasonal peaks historically did not overlap. This overlap also coincides with new COVID-19 variants, making all three viruses prevalent and infecting children during the same season.  
Who is at risk?
It’s very similar to who is at risk for any viral infection. While both school-age and younger children are becoming infected with any of these viruses, younger toddlers and infants are at increased health risk when infected.  This is because they have smaller airways that can get clogged more easily. Any of these viruses can cause increased secretions leading to a stuffy nose and post-nasal drip that can make it especially difficult for children to breathe and eat, drink, and stay hydrated. 
Who is at the highest risk?
Premature infants or those with underlying medical issues (like heart, lung, or metabolic issues) are also at increased risk. 
Why does it seem like there are so many more viruses with severe impact this year?
With eased COVID precautions, many infants and children are now getting exposed to these viruses for the first time.  This means they lack something called ‘acquired’ immunity – immune cells that remember a virus (or similar ones) and are better equipped to fight it.  This lack of acquired immunity, coupled with fewer masks in public places, has led to more concurrent viruses with more severe or even more prolonged symptoms.  
Is it possible for a child to get more than one of these viruses at once?
Definitely — and we are seeing more of this, which can be tough on kiddos and their parents.  It’s also not atypical to see a new infection occur just as another is improving – which can be frustrating to parents.  
What should parents look out for when their child has one (or more!) of these viruses?
These viral infections generally begin with signs of the common cold: nasal congestion, nasal discharge, and cough.  Symptoms may then progress to more severe respiratory or airway symptoms like more frequent coughing, wheezing, and difficulty breathing.  In RSV, the worst of these airway symptoms typically occur on the third day of symptoms.  But with flu or COVID-19, symptoms may be prolonged.
What can parents do to care for their sick child? 
I know I’ve said it before, but the key in any of these viruses is ensuring your child is “eating, drinking, pooping, and peeing.” 
Parents need to try to support their child through the illness.  With all that congestion and their nasal passages blocked, they’ll be less interested in eating. In my Respiratory Illnesses Class, I demonstrate how to correctly use a bulb suction and a NoseFrida to clear nasal passages.  Use one of these suction methods with nasal saline prior to feeding and sleep to give your child the upper hand.  Also, offer them smaller, more frequent meals.
When should I seek further care?  
If your child exhibits any of the following, take them to Emergency Department or call emergency services:

  • Grunting to breathe
  • Stops breathing
  • Overly tired from working to breathe
  • Severe depression of the skin around the ribs when breathing
  • Blue-tinged skin

If your child exhibits any of the following, take them to or call their medical provider:

  • Decreased oral intake
  • Signs of dehydration like more dry diapers, less peeing than normal, dry tongue, lips, or mouth. You can also do the Nail Bed Test I demonstrate in my Vomiting, Diarrhea, and Dehydration class. 
  • Under 4 months of age and have a temperature of 100.4F or higher

How can parents help prevent infection from these viruses?
One of the reasons that these viruses are so common is that they’re all very contagious and can live on surfaces for prolonged periods of time. Make sure you’re washing hands with soap and water or using hand sanitizer and frequently cleaning common surfaces at home to prevent the spread of viruses this season. Children can start getting the flu shot at 6 months of age (they require two doses during the first flu season). Similarly, the CDC is now recommending COVID-19 vaccination for children greater than 6 months of age.
For more on treating seasonal illnesses like these, as well as fevers, the common cold, and croup, check out our safety classes, led by Dr. Parsons.