pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

How To Tell The Difference Between Flu and Colds

1. Flu and Colds: Why bother?

   Well, it’s true that for the most part and in normal circumstances symptomatic treatment is all that is recommended in either instance. However, true influenza (the only disease which should be called “the flu”) does carry with it the risk of a few more complications – some of them quite serious.

   Additionally, how serious you are about things like hand-washing, isolation and the steps you take to prevent spread to others matters a lot. Infants and elderly are especially vulnerable to serious complications and so is anyone who is respiratory or immune compromised. If you have the flu you don’t want to go anywhere near those people.

   Those individuals with compromised health situations may be given prescription antiviral medications in hopes that it may cut the time they are sick or severity of their illness. If so, identification that it is influenza needs to be done very early.

2. Flu: Onset is rapid and hard

   I realize that most of the symptoms we mention are relative to what you’ve experienced before; but, compared with a normal “cold” you usually really know “this thing is different” when you get the “flu.”

   I can tell when I get it because it usually feels like I’ve been “hit by a truck” (a metaphor used by those of us who have never been hit by an actual truck). Flu usually attacks more suddenly and with more systemic symptoms like muscle aches and fatigue. There may be sore throat, fever and headache but often not, and there may even be congestion and cough but those are more prominent in colds.

   In a healthy, vigorous person, the majority of flu symptoms fade over 5 to 7 days; or, it can linger longer, even a couple of weeks. On the other hand, colds nearly always focus their symptoms in your head with congestion, dripping, coughing and headaches, come on gradually and linger 5 to 10 days.

3. Fever: Probably Flu

   If a cold begins with a fever, it most often is light and only transient; but, most cases of colds do not cause fevers. With the Flu, at least an initial fever is quite common to 100.4° F (28°C) or higher.

   In children, it’s a little different. They more frequently do develop a slight fever with a cold and with Flu the temperature tends to be higher.

4. Fatigue: Can last weeks with Flu

   The muscle aches, tiredness and general “yukky” feeling can be prominent and last up to two weeks or longer with the flu. Especially in the elderly, very young and people with chronic medical conditions or a weak immune system.

   A cold, on the other hand, usually goes away within a couple of days.

5. Headaches: Both Flu and colds

   Having a headache isn’t much help in differentiating between Flu and colds because both can cause them; and, unless you can compare experiences it’s difficult to tell “how bad is bad.”

   For the record though, the Flu does cause headache a bit more frequently and a bit more severe than a cold.

6. Cough: Both Flu and colds

   Influenza and cold viruses are both respiratory illnesses. That said, viruses which cause colds usually limit themselves to the upper portion (nose, throat) while influenza migrates into the lower portions (lungs) much more readily.

   Both cause coughing, Flu can cause pneumonia of the lungs. Difficulty breathing, shortness of breath, chest pain, wheezing and coughing up green or bloody phlegm are all signs that you should see your doctor; because, it’s probably the flu.

7. Earaches: Both Flu and colds

   Being in close proximity to the nose and throat, the Eustachian tube will often become closed with mucous during either a cold or the Flu; and because that is what drains the middle ear of pressure, ear discomfort may develop.

   Cold and flu-related earaches usually go away by themselves, however ears can become infected themselves after prolonged mucus plugging even with a second organism. In that case the ear pain would last longer than your first illness, there may be a sudden increase in ear pain or a fever may return after it has previously passed. A doctor will need to evaluate for possible antibiotics (for the secondary ear infections, not the cold or Flu).

8. Sore Throat: Colds

   A progression of sore throat, painful swallowing, runny nose, sneezing, congestion and cough is about the most classic course of a cold.

   Even though sore throats may accompany the Flu, it is most often accompanied by tiredness and muscle symptoms happening all at once.

9. Stuffy nose: Colds

   A stuffy nose as a beginning symptom, unless accompanied by fever and body aches, usually means you’re coming down with a cold.

   But, by now you know the drill, the Flu can also produce a stuffy nose and sneezing. And, just like I mentioned above about the earache, prolonged congestion can also lead to a secondary sinus infection. Pain or discomfort in the cheekbones, forehead, bridge of the nose which increases with head movement or touching is reason for a doctor’s visit and evaluation.

10. Treatment: Flu and colds

    Both being caused by viruses, there is NO medicine which will cure the disease. There are, however, a lot of medications which will make you feel more comfortable – this is a multi-billion dollar industry.

    Over-the-counter medicines including decongestants, cough suppressants and antihistamine can help congestion, cough and nasal symptoms respectively. Pay careful attention to the labeling because many medicines come in odd combinations which may be duplicated into an overdose if you combine them with other compounds.

    Muscle aches and pains (like in the Flu) are eased, often dramatically, by Ibuprophen or acetaminophen. But remember, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin as it has been related to the often fatal Reye’s syndrome.

11. Treatment: Flu

    Although there is nothing specific to treat the Flu, doctors “borrow” some technology from the treatment of cancer’s and AIDs and sometimes use anti-viral medications to help diminish the severity of a Flu attack in people who are at risk for having severe complications.

    They cannot stop the virus but sometimes will blunt it’s duration or severity enough to help. They are expensive and not without side-effects of their own so aren’t recommended for everyone who develops Flu-like symptoms. If your doctor has informed you so, the best time to begin anti-virals if they are going to work is “yesterday” – meaning that “the sooner the better.”

12. Prevention: Flu and Colds – Hand Washing

    It is incredible to watch a household and their hand-washing practices. Cold and Flu viruses are incredibly contagious and do it by hitching a ride on “fomites” – tiny sprays of mucous, spit and other such carrier vehicles that float in the air for minutes and drop to every surface.

    The thing is that coughs can be easily dampened and surfaces can be easily washed. The most easy and available is to wash your hands! And think about when you need to do it. Not only after touching something that might be contaminated; but, BEFORE you put them in your own mouth or around your nose and eyes. Them and anything they have held.

    Handwashing needs to be with soap and warm water – AND CONTINUE FOR AT LEAST 20 SECONDS. Studies have shown that, unless “enlightened,” members of households are lucky to wash more than 5 seconds! Alcohol-based hand sanitizers work too, if used for a similar length of time.

    Teach your household to Sneeze or cough into their elbows instead of their hands. In the hospital, our mantra is: “catch it, kill it, trash it!”

13. Prevention: Flu – yearly immunization

    A yearly flu shot is recommended for nearly everyone now, especially the young, elderly, those with any chronic diseases and those in the middle who don’t want to get it. In fact, it’s easier to ask your doctor if you have a reason NOT to have one.

    Influenza attacks at any time, BUT it has highly seasonal peaks. It also “morphs” frequently into a different form than it was last year so predicting what future form will be attacking this year isn’t easy – especially with enough lead time to manufacture millions of doses of vaccine. We do it though, and have been amazingly successful at it. [And by “we” I mean “they” – I personally didn’t have much to do with it.]

    As you know, vaccines are versions of the flu virus which have been rendered incapable of causing disease. Your body, however, recognizes it as a virus and produces anti-bodies which will hopefully then disallow the “real” virus from attacking you.

    In spite of what has been carelessly gossiped about (or may be on the internet) Flu shots do NOT give you the flu because they can’t. In early days some of the vaccines would occasionally cause “symptoms” but it wasn’t the “flu.” Additionally, there is always the chance that “we” have guessed wrong about which “bug” would hit this year and you could catch a different flu virus. In that case, often your vaccination could make what you do catch less severe and shorter.

    And, lastly, the shots are especially important for pregnant women, older adults and those with chronic illness or who have suppressed immune systems.