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

Current Influenza Activity

CDC Weekly US Map: Influenza Summary Update  

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
If test result is unavailable prior to floor transfer, inpatient team can begin oseltamivir when test results are available
Child stable for discharge
Assess risk of influenza complications
Based on individual factors of the child
Children considered at risk
for influenza complications
≤ 12 months old

  • 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 months
    or with chronic condition
Testing recommended
12-24 months 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 months old
No chronic condition, social factor
No testing or treatment recommended
  • Consider COVID Test
  • There is a current oseltamivir shortage
  • Treatment of low-risk children is not recommended
Rapid quad panel results
POSITIVE flu result
NEGATIVE flu result
  • Oseltamivir is most likely to be effective within 48 hrs of symptom onset
  • Review benefits/risks with child/family
  • Provide 1st dose of oseltamivir in ED
No treatment
Posted: January 2013
Revised: January 2023
Authors: A. Weiss, MD; R. Scarfone, MD; J. Lavelle, MD; B. Ku, MD; J. Hemberger, MD; J. Molnar, CRNP; K. Cohn, MD; K. Castelo, CRNP; T. Metjian, PharmD