Treatment of Influenza in Children Under 5 Years of Age
Yes, children under 5 years of age with influenza should be treated with antiviral medications, with oral oseltamivir (Tamiflu) being the antiviral drug of choice for influenza virus infections in this age group. 1
Recommended Antiviral Medications
The American Academy of Pediatrics (AAP) considers oral oseltamivir (Tamiflu) the antiviral drug of choice for managing influenza virus infections in children under 5 years, including infants from birth. This is due to cumulative experience with this drug in children, relative cost, and ease of administration. 1
Oseltamivir is FDA-approved for treatment of influenza in children as young as 2 weeks of age. 1, 2
For children under 1 year of age, oseltamivir can be used to treat influenza in both term and preterm infants from birth because the benefits of therapy outweigh possible risks of treatment. 1
Dosing Guidelines
For children 1 year and older, oseltamivir dosing is weight-based:
- ≤15 kg: 30 mg twice daily
15-23 kg: 45 mg twice daily
23-40 kg: 60 mg twice daily
40 kg: 75 mg twice daily 1
For infants under 1 year:
- 0-8 months: 3 mg/kg/dose twice daily
- 9-11 months: 3.5 mg/kg/dose twice daily 1
For preterm infants, dosing is lower than for term infants due to immature renal function. Dosing should be based on postmenstrual age (gestational age + chronologic age). 1
Timing and Duration of Treatment
Treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. 1
The recommended duration of treatment is 5 days. 1
Even when started after 48 hours of symptoms, treatment with oseltamivir should still be considered for children with serious, complicated, or progressive disease. 1
Clinical Benefits of Treatment
In children with laboratory-confirmed influenza, oseltamivir reduces the median duration of illness by 36 hours (26%). 1, 3
Oseltamivir significantly reduces the risk of acute otitis media in children 1-5 years of age with laboratory-confirmed influenza. 1, 4
Treatment with oseltamivir is associated with faster return to normal activities and reduced use of relief medications. 3
In children with influenza A, oseltamivir treatment is associated with improved recovery and shorter hospital stays. 1
Alternative Antiviral Options
Inhaled zanamivir (Relenza) is an acceptable alternative for patients 7 years and older who do not have chronic respiratory disease. 1
Intravenous peramivir (Rapivab) is approved for treatment of acute uncomplicated influenza in ambulatory children 6 months and older who have been symptomatic for no more than 2 days. 1
Safety Considerations
Vomiting is the most common side effect of oseltamivir, occurring in approximately 5% of treated patients. 1, 3
The balance between benefits and harms should be considered when making decisions about the use of neuraminidase inhibitors for treatment. 1
Despite limited evidence from prospectively conducted trials, treatment with oseltamivir for children with serious, complicated, or progressive influenza disease is recommended regardless of when illness began. 1
Specific Recommendations for High-Risk Groups
- Treatment should be prioritized for:
Important Clinical Considerations
Diagnostic testing for influenza should not delay the initiation of antiviral therapy in children under 5 years with suspected influenza. 1
The clinical efficacy of neuraminidase inhibitors in "at risk" children still needs further study with larger high-quality trials. 4
Influenza vaccination remains the primary tool for prevention of influenza, with antiviral medications serving as an important adjunctive measure. 6