Colds and viral respiratory infections are incredibly common among children of all ages. They also seem to come and go pretty quickly, albeit miserably. But what many patients chalk up to a ’24-hour’ cold or flu has likely been hanging around for a week or more.

“When it comes to the 24-hour flu, we usually associate it with more dramatic symptoms – fever, fatigue, and body aches,” says Dr. Keyvan Rafei, MD, Chief Medical Officer and cofounder of Culex Wellness. “But it turns out there are symptoms present before the illness that are misinterpreted or ignored.”

Understanding the phases of viral illness, he says, can help us anticipate symptoms, identify potential complications, and avoid unnecessary treatments.

Almost all viruses enter our bodies through the eyes, nose, or mouth.

“It’s where the outside meets the inside,” Dr. Rafei says. “If someone sneezes in front of us, or we touch a door handle that has been contaminated with the virus, and then we touch our eyes – that’s how they enter the body.”

Interestingly, he notes, the point of entry is typically the first to feel lousy. If the virus enters through the eyes, itchiness may occur – or some discharge and redness. Through the nose? Stuffiness and runniness are par for the course.

“If the virus enters primarily through the throat, we may experience a sore or scratchy throat. Babies may start drooling more because it’s uncomfortable to swallow their saliva,” Dr. Rafei says. “That phase in a baby often coincides with the teething process, causing parents to blame the discomfort on the teething.”

Similarly, symptoms are at their most subtle at the beginning of a viral illness. As a result, they are frequently misinterpreted. Mild nose congestion or eye discharge can easily be – and often is – attributed to allergies.

From these early signs, the virus begins marching down into the body’s systems via the respiratory or gastrointestinal tract, at each stage causing more unique symptoms.

“As the virus marches along, it starts yielding other clues,” Dr. Rafei says. “If it’s a respiratory virus, all of a sudden it goes to our upper airways, and we start coughing. Some adults lose their voice because their vocal cords become swollen and don’t vibrate in the same way.”

Children, he says, frequently get a bark-like cough, often referred to as croup.

“The reason kids get the barking cough and adults get more of what we call laryngitis is simply a function of the caliber of the upper airways,” he continues.

The inner lining of the throat becomes swollen, but for adults – there is still plenty of room for air to pass.

“So, they don’t have what we call turbulent or ‘noisy’ airflow. Adults can breathe as they did. In children, the size of the airways is smaller, so even a little bit of swelling causes a significant reduction in caliber. All of a sudden, there are more high-pitched sounds, like a barking seal type of cough. Kids sometimes have a hoarse cry, which is another clue that something is evolving.”

Over the next few days, the virus migrates, affecting the throat, lungs, and stomach.

“If it’s a gastrointestinal virus, we may have stomach pains, bloating, and eventually loose stools. On the other hand, a respiratory virus will go down the airways and cause a deeper cough, sometimes with mucus and phlegm, which is usually worse at night rather than in the day.”

This systemic or “whole body” phase of the virus can cause rashes, body aches, and frequently fever – the latter of which helps to “boil off the infection.” It is also the phase in which most people say, “I think I’m coming down with something.”

“We don’t realize that we are already halfway through the illness,” Dr. Rafei says. “Nonetheless, we start looking for relief.”

As the body’s defenses start mounting, we’re actually on the road to recovery. But discomfort tends to win out, and we seek out antibiotics instead of letting the virus run its course.

“We’re not always patient enough to wait for it,” Dr. Rafei says. “We take antibiotics, and we get better – and then we associate the antibiotics with getting better. That’s where the confusion lies. We mistakenly refer to this entire process as a ’24-hour’ cold or flu. In reality, we’ve been fighting it off for a week.”

What first appears as a random set of symptoms actually follows a predictable pattern. This awareness can help us anticipate and cope with an evolving cascade of symptoms – and mitigate the misery of the 24-hour cold or flu.

“On the other hand, if we get past the systemic phase of the illness but still have a recurrent fever, we must consider the possibility of a secondary or complicating bacterial infection,” Dr. Rafei says.

If that happens, talking to your doctor is a very good idea.

Culex Wellness can help. Regular check-ins with our team can prevent ER visits by mitigating illness before it becomes severe. Reach out to us today.