Flu, COVID, or Just a Cold? How to Tell if a Nonverbal Child is Sick.

A few years ago, I got one of those dreaded calls from Kevin’s school nurse. He seemed off, just not himself, clearly not feeling well. Something in my gut told me to call the pediatrician while I was driving up there, and there were able to squeeze me in. The school nurse was right, he looked terrible.

This was 2021 or 2022, I don’t remember. So, not peak COVID season, but COVID was still on our minds. I drove him to the ped’s office on the way home, and I remember it was a nurse practitioner who I have never met before, nor had Kevin.

I was concerned–I know my kid. I remember leaving extremely pissed off, because she was very dismissive. “There’s a lot of stuff going around besides COVID, it could be just a cold.”

Anyway, long story short, since we still had COVID tests (remember those??) we did it once he fell asleep. Those little stripes lit up right away. Thankfully, he already had his g-tube then, so I could keep him hydrated and fed. But he honestly slept for almost 72 hours straight.

But, more on advocating at the doctor in a minute.

Remember how, for a few years, social distancing and mask‑wearing magically made flu nearly disappear? Well… not this year. According to the Centers for Disease Control and Prevention (CDC), the 2025–2026 flu season is heating up: as of early December, there have already been over 1.1 million illnesses, 11,000 hospitalizations, and 700 deaths attributed to flu.

Flu activity is rising across most of the U.S.; it’s growing or likely growing in 39 states. At the same time, COVID-19 hasn’t vanished; in many states infections are again creeping upward. Bottom line: this holiday season, respiratory viruses are circulating again (including flu and COVID) meaning we need to stay alert, especially for families with medically fragile or non‑verbal children.

Why this is especially important for non‑verbal or medically fragile kids

For most of us, a cold or mild flu might just feel annoying. But for children with neurological conditions, developmental delays, or medical complexity, flu (and other respiratory illnesses) carry much greater risk. The flu can lead to serious complications like pneumonia — or worse.

Many non-verbal children have difficulties with muscle strength, lung function, swallowing, or clearing fluids — all of which make it harder to fight off a respiratory illness. That’s why what might look like “just a sniffle” to others can become serious for them.

When your child can’t tell you how they feel… that raises the stakes. It means YOU need to be extra vigilant.

Why Illness May Look Different in Disabled or Medically Complex Kids

These are just a few reasons why kids with disabilities may have a harder time showing (or fighting off) flu, COVID, or other infections: As public health officials consider the risks of loosening vaccine requirements, it’s crucial to evaluate the potential impact on vulnerable populations. Children with disabilities often rely on community immunity to safeguard their health, making any changes to vaccination policies a matter of significant concern. Ensuring that these children remain protected is a priority as we navigate the complexities of public health strategies.

• Hypotonia (low muscle tone): Can make it harder to generate a strong cough. This means they may not clear mucus well, making respiratory infections more dangerous.
• Apraxia or Motor Planning Issues: Can affect how your child swallows or uses muscles needed for coughing, drinking, or even signaling that something hurts.
• Sensory Processing Differences: Some kids may not register pain, fever, or discomfort the same way, or they may not react in a way adults expect.
• Communication Delays or Nonverbal Status: Obviously makes it harder to say “I don’t feel good” or describe symptoms like sore throat, dizziness, headache, or nausea.
• GI Disorders or Feeding Challenges: Kids who already struggle with eating may quickly become dehydrated or refuse food even sooner when sick.
• Seizure Disorders (like Epilepsy): Illness, fever, and even over-the-counter medications like Benadryl can increase seizure risk. Always double-check with your doctor.
• Neurological Conditions: Many kids with brain-based diagnoses (e.g. cerebral palsy, autism, developmental delays) are at higher risk for complications like pneumonia.
• Immune Dysfunction: Some children with genetic syndromes or chronic illnesses may have suppressed or compromised immune systems.
• Limited Physical Mobility: If your child spends most of their day in a wheelchair or bed, mucus can pool in the lungs more easily, increasing the risk of pneumonia.

Signals a non‑verbal child may be sick

If you have a non‑verbal child, here are signs to look for (beyond “fever plus cough”) that could indicate something serious:

• Rapid onset of symptoms (flu often hits hard and fast, think weakness, fever, aches).
• Changes in breathing: raspy, labored breathing, wheezing, or trouble catching breath.
• Unusual change in skin or eye color (paleness, grayness, or unusual flushed skin) or rashes.
• Extreme drowsiness, difficulty waking, or acting “off” or more sleepy than usual or very hard to rouse.
• Behavior changes: unusually irritable, refusing tasks or food, refusing favorite things or routines.
• Trouble walking, unsteady gait, or seeming confused/“drunk.”
• Holding head or neck oddly, tilting head, or other “posturing,” especially, could be sign of head/neck pain (or worse).
• Vomiting, especially repeated or violent vomiting.
• Very little or no interest in eating or drinking; signs of dehydration, fewer wet diapers/urination, darker urine, dry mouth, lack of tears.
• Changes in respiratory secretions: thick, green mucus; persistent congestion, coughing, especially if not just a mild cold.

And remember….your gut. If something feels off, even if it’s subtle, trust it. You’re the parent, and often the only one who knows what “normal” looks like for your child.

Smart tools and tricks — because checking temp or hydration isn’t always easy

Here are some practical tips for non‑cooperative or non‑verbal kids:

• Use instant-read or no‑touch thermometers (forehead, temporal, or behind ear). They’re quick, less resistance, less stress.
• For hydration: offer small, frequent sips of water, electrolyte solutions, popsicles, ice chips or whatever they will tolerate. This helps if they won’t drink big gulps.
• Use visual cues (for older non‑verbal kids who can point or gesture): show them picture‑card or board images for “thirst,” “hurt,” “tired,” “bathroom,” “hot,” etc. Having a communication board ready helps them express needs even if they can’t speak.
• Keep record sheets or a journal (phone note, binder… whatever).
• Track: changes in sleep, appetite, behavior, breathing, mood, fluid intake, output (diapers / bathroom), skin tone, positioning/posturing, etc. This gives you concrete data to show a doctor and helps you make better-informed decisions.
• When in doubt, call your pediatrician and ask for guidance even if it’s “just a little off.”

Advocating at the Doctor or Urgent Care

If you’ve ever left urgent care or a doctor’s office feeling dismissed, you’re not alone. Many of us have been brushed off with “it’s just a virus” or “they look fine to me” especially when our kids don’t present symptoms in the neat little boxes medical textbooks love.

But here’s the thing: you know your child. They don’t. When you’re advocating at a clinic or urgent care where staff don’t know your child, don’t be afraid to speak up and be that mom. Bring the receipts, literally, if you can.

Keep a simple symptom tracker or log: what’s changed, when, how often, how severe. If your child is non-verbal, explain exactly how they communicate pain or discomfort.

• “This hand-flapping is new.”
• “He usually loves food, now he refuses even snacks.”
• “She’s been sleeping 14 hours a day and still groggy.”

Concrete examples help validate your concerns. And if you’re getting brushed off? Politely push back. Say: “I understand you’re not seeing typical signs, but I need you to know, this isn’t typical for my child.” Or: “Can you note in the chart that I’m requesting further testing or observation?”

Sometimes, just showing them you’re documenting and taking names is enough to make them take a second look. And if they still won’t listen? Ask to speak to a supervising physician or go elsewhere. You’re not overreacting. You’re protecting your kid.

How to lower flu risk this holiday season

• If you haven’t already, get the flu vaccine for everyone (starting at 6 months old). The CDC recommends flu shots for all children 6 months and older. (or they used to, list to doctors not YouTube charlatans)
• Try to reduce exposure: frequent hand‑washing, avoid crowded indoor spaces when possible, especially if flu or COVID is circulating.
• Stick to good self‑care: lots of sleep, nutritious food, hydration, rest. Especially with medically fragile kids, their bodies need extra care.
• Be ready. Have a plan if your child gets sick: know your doctor’s number, how to get quick help (urgent care vs ER), and have basic necessities stocked (thermometer, hydration options, communication tools, list of medications, etc.).

You don’t have to be a “flu detective,” but vigilance matters.

Yeah, I get it. Worrying about flu while juggling therapies, IEPs, sensory meltdowns, behavior plans, doctor appointments… it’s a lot. But for non‑verbal and medically fragile kids especially, staying alert and prepared this season can literally make a difference.

You don’t need to obsess, but do what we autistic/special‑needs moms do best: trust your gut, observe, record, adapt. If you notice anything “off,” act quickly. Remember: you know your child better than anyone.

A special thanks to Aria Health Care for contributing to this article. Flu shots are available at both of Aria Health’s Fast Care locations in Northeast Philadelphia or Levittown, PA with no wait and no appointment necessary. Aria introduced its FastCare clinics in 2013 to offer members of the community convenient, walk-in access to non-emergent healthcare services without the wait. (Site owner’s note: It appears that Jefferson Health purchased Aria since this article was written. Make sure you confirm details and locations online before visiting.)

I’m not a doctor nor do I play one on the internet. Always consult your doctor if you have questions.