# Influenza and COVID-19 in Children

> Influenza and COVID-19 in children for NEET-PG Paediatrics covering clinical features, oseltamivir indications, vaccine advice, MIS-C and post-COVID syndromes.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/influenza-and-covid-19-in-children
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Nelson Textbook of Pediatrics; Ghai Essential Pediatrics
- How to cite: "Influenza and COVID-19 in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/influenza-and-covid-19-in-children

## Direct answer

Influenza and COVID-19 in children are usually self-limiting febrile respiratory illnesses. High-risk children need prompt antiviral treatment for influenza and annual vaccination, while MIS-C is the serious post-infectious complication of SARS-CoV-2 that needs urgent inpatient care. Oseltamivir is reserved for severe, progressive or high-risk influenza.

## What you must remember

- **Influenza features:** abrupt fever, myalgia, cough and coryza; complications include otitis media, pneumonia, febrile seizures and encephalopathy.
- **Oseltamivir indication:** severe or progressive illness, hospitalised children and high-risk children such as those under five or with chronic lung or heart disease, ideally started within 48 hours of onset.
- **Not for mild disease:** a well child with uncomplicated influenza does not routinely need oseltamivir, which is a common exam point.
- **Influenza vaccine:** an annual inactivated vaccine from six months of age; children under nine years getting it for the first time need two doses at least four weeks apart.
- **COVID-19 in children:** usually mild, with higher risk in children with chronic disease, obesity or immunosuppression.
- **MIS-C:** a few weeks after infection, with fever, rash, conjunctivitis, gut symptoms, shock and raised inflammatory markers, plus cardiac involvement.
- **MIS-C treatment:** intravenous immunoglobulin and corticosteroids with supportive care, and echocardiography to watch for coronary artery involvement.

## Telling the two infections apart at the bedside

The two illnesses overlap heavily in children, so the features below guide the approach rather than a single sign. The table sets out the practical differences.

| Feature | Influenza | COVID-19 |
|---|---|---|
| Onset | Usually abrupt | Often gradual, sometimes abrupt |
| Typical symptoms | Fever, myalgia, cough, coryza | Fever, cough, sore throat, vomiting or diarrhoea |
| Antiviral use | Oseltamivir for severe or high-risk disease | Limited to severe or high-risk disease per guidance |
| Serious complication | Pneumonia, encephalopathy | MIS-C, post-COVID condition |
| Test used | Influenza PCR or rapid antigen test | SARS-CoV-2 RT-PCR or antigen test |
| Risk group | Under five, chronic disease, pregnancy | Chronic disease, obesity, immunosuppression |
| Prevention | Annual inactivated vaccine | Vaccination per the current national advice |

A positive test, not symptoms alone, separates the two diseases, and local influenza and COVID-19 activity helps decide which test to send first. Any child with fever and shock after a recent infection should be evaluated for MIS-C even if the acute illness seemed mild.

## Where the exam tries to catch you

Infection questions turn on timing and risk group. Watch for these traps.

- **Trap:** Prescribing oseltamivir to every child with fever and cough in influenza season. — **Correct:** Antiviral therapy is for severe, progressive or high-risk influenza; a well child with mild disease is managed supportively.
- **Trap:** Assuming MIS-C appears during the acute COVID-19 illness. — **Correct:** MIS-C follows the infection by a few weeks, so the child may seem recovered and then develop fever, shock and inflammation.
- **Trap:** Treating persistent fatigue after COVID-19 as psychological. — **Correct:** Post-COVID condition is a recognised syndrome; the child needs structured review and exclusion of other causes.

## Frequently asked questions

### When should oseltamivir be started in a child with influenza?

Oseltamivir is ideally started within 48 hours of symptom onset in children with severe, progressive or high-risk influenza, including children under five years and those with chronic lung or heart disease. Treatment can be considered later in severe illness, but the benefit is greatest when started early.

### What is MIS-C and how is it treated?

Multisystem inflammatory syndrome in children is a post-infectious complication of SARS-CoV-2 that causes fever, rash, conjunctivitis, gut symptoms and sometimes shock. It is treated with intravenous immunoglobulin and corticosteroids alongside supportive care, and echocardiography is used to watch for coronary artery involvement.

### Which children should receive influenza vaccine each year?

Children aged six months and older should receive an annual inactivated influenza vaccine, with priority for those with chronic lung, heart, kidney or metabolic disease. Children under nine years who have never had influenza vaccine need two doses at least four weeks apart in their first season.

### Does COVID-19 cause long-term symptoms in children?

Some children have persistent symptoms after acute COVID-19, including fatigue, headache, poor concentration and sleep disturbance, a picture termed post-COVID condition. The diagnosis is one of exclusion, so other causes should be sought before attributing symptoms to the earlier infection.