Influenza/Flu Clinical Pathway – Emergency Department | Children's Hospital of Philadelphia

Influenza-like Illness (ILI)

Fever ≥ 100.4°F and Cough

and/or Sore Throat

During Influenza Season

PPE and Isolation Recommendations

Mask in triage for child and caregivers
Mask, eye protection, HH, gloves for care providers
- (gowns per symptoms)

Child Requires Admission

All children requiring admission are considered at higher risk for
influenza complications

Testing Recommended

Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV

Test Result	Action
Positive	Begin oseltamivir
Negative	Do not begin oseltamivir

Offer oseltamivir even if > 48 hrs have elapsed since illness onset

Child Stable for Discharge

Assess risk of influenza complications
Based on individual factors of the child

Children considered at risk
for influenza complications

< 12 mos

Chronic Conditions
Pulmonary (e.g., Asthma), cardiac, renal, hepatic, hematologic, metabolic, neurologic
Immunosuppressed
Long term ASA therapy
Morbid obesity
Social Factors
Resident of chronic care facility
Household contact < 6 mos
or with chronic condition

Testing Recommended

12–24 mos Old and Moderately Ill
No chronic condition, social factor

Consider Testing

Additional Considerations
Consider testing/treating only if symptoms are present < 48 hrs

Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV

Children considered to be at low risk for influenza complications

> 24 mos Old
No chronic condition, social factor

No testing or treatment recommended

Rapid quad panel results

Positive flu result

Negative flu result

Flu A positive, refer to
avian influenza screening

Treatment Recommendations

No Treatment

< 12 mos or chronic conditions
- Begin oseltamivir
12–24 mos without chronic condition
- Consider oseltamivir
  - Symptoms present < 48 hrs
  - Based on symptom severity
Note
- Oseltamivir most likely to be effective if given within 48 hrs of symptoms
- After hours, provide 1^st dose of oseltamivir in ED

Posted: January 2013
Last Revised: January 2026
Authors:
- K. Cohn, MD
- L. Klingensmith, MD
- R. Scarfone, MD
- J. Lavelle, MD
- B. Ku, MD
- J. Molnar, CRNP
- K. Castelo, CRNP
- T. Metjian, PharmD
- L. Grimes, MD
Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Emergency Department Clinical Pathway for the Evaluation/Treatment of Children with Suspected Flu

Evidence