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 patient and caregivers
  • Mask, eye protection, HH, gloves for care providers
    • (gowns per symptoms)
Patient Requires Admission
All Patients 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 as indicated
Patient Stable for Discharge
Assess Risk of Influenza Complications
Based on Individual Patient Factors
Patients 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:
Oseltamivir most likely to be effective within 48 hours of symptom onset
Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV
Patients 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
Rapid Quad Panel Results
POSITIVE Flu result
NEGATIVE Flu result
UNKNOWN Flu results
at time of ED Discharge
  • 1st dose oseltamivir in ED
  • No treatment
  • Consider treating presumptively with
    • 1st dose oseltamivir in ED
  • Discharge with paper prescription
  • Instruct family to check MyCHOP for
    • test results
Posted: January 2013
Revised: December 2021
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