Reasons to seek medical attention:

  • Your child has a severe symptom, such as difficulty breathing, shallow breathing, significant fever, altered mental status, significantly poor oral intake, low urine output
  • Your child’s illness is not getting better in the expected amount of time
  • You are concerned that the infection could be bacterial (i.e. ear infection, strep throat, pneumonia) and may require antibiotics


If you are confident that the illness is not severe and likely viral in nature, then consider the following interventions:

1. Things that boost the immune system

For children who cannot swallow pills, liquid Elderberry syrup is a good choice. Elderberry has been shown to reduce symptom severity and/or duration for the common cold and/or influenza.1,2,3,4,5,6 Additionally, we believe it is reasonable to supplement with Vitamin C and Zinc during an infectious illness.7 Liquid or chewable forms of these supplements that are designed for children are generally readily available at places like Whole Foods.


2. Things that directly reduce symptoms

Symptom reduction is likely more important for children than it is for adults. Whereas some adults may prefer to “tough it out” or let the immune system run its natural course, children often do not have the capacity to share this perspective. Additionally, more aggressive symptom control may help prevent the need for escalation to higher level of care (i.e. Emergency Room). If your child is completely miserable, it may be difficult to say that they don’t have a more severe illness. Additionally, if the symptoms interfere with the child’s ability to (1) eat properly and (2) sleep properly, then this will negatively affect the child’s immune system and ability to fight the infection.

The most powerful tool we have for reduction of symptoms in a pediatric viral illness is Motrin. It is often thought that Motrin is only for fever reduction; however, the anti-inflammatory nature of Motrin makes it also helpful for cough, muscle pains, headaches, and how the child generally feels overall. Motrin can be taken every 6 hours as needed. Tylenol can also be used every 6 hours (either in between Motrin doses or concurrently) if Motrin by itself is ineffective. For dosing, defer to the instructions on the box.

Other interventions that may be helpful include the following:

  • Nasal saline
  • Nasal suctioning
  • Steam therapy

We tend to recommend against the routine use of OTC children’s cough and cold medications. Rarely, they are associated with potentially life-threatening side effects. They are explicitly contraindicated in children less than 2 years old and manufacturers generally recommend against giving it in children less than 4 years. 


Should I test my child for COVID?

The decision about whether or not to test your child for COVID will likely not really a “medical” decision because there is no FDA-approved treatment for COVID in children, therefore, testing does not change the management of the illness. That being said; however, you may wish to test your child for COVID for logistical reasons. For example, your child’s school or daycare may require a negative COVID test for any illness and/or it may affect the way that your child (and your family) approaches quarantine and isolation. In general, OTC rapid antigen testing is an acceptable way of testing for COVID, although PCR testing is technically more accurate.



  1. Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-369. doi:1089/acm.1995.1.361
  2. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132-140. doi:1177/147323000403200205
  3. Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70(10):1255-1261. doi:1016/j.phytochem.2009.06.003
  4. Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-365. doi:1016/j.ctim.2018.12.004
  5. Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. Published 2016 Mar 24. doi:3390/nu8040182
  6. Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021;21(1):112. Published 2021 Apr 7. doi:1186/s12906-021-03283-5
  7. Maggini S, Beveridge S, Suter M. A combination of high-dose vitamin C plus zinc for the common cold. J Int Med Res. 2012;40(1):28-42. doi:10.1177/147323001204000104