Pediatrics FAQ: Evidence-Based Answers to Today’s Most-Searched Clinical Questions

This Pediatrics FAQ page delivers concise, evidence-based answers to the clinical questions pediatricians and healthcare professionals are searching for right now. Drawing on the most recent US search trends and grounded in peer-reviewed literature, these summaries address common, high-impact pediatric concerns—from RSV and influenza management to measles exposure, community-acquired pneumonia, and norovirus outbreaks. Each response is designed to support point-of-care decision-making with clear, current guidance and authoritative references, helping clinicians translate emerging epidemiologic signals into best-practice care.

What is the most evidence-based strategy to prevent severe respiratory syncytial virus (RSV) disease in infants this season?

For most US infants entering their first RSV season, the highest-impact prevention strategy is single-season passive immunization, using either (1) maternal RSV prefusion F (RSVpreF) vaccination in late pregnancy or (2) infant nirsevimab, rather than layering both routinely.

In the phase 3 MELODY trial, nirsevimab reduced medically attended RSV-associated lower respiratory tract infection (LRTI) vs placebo with a favorable safety profile, supporting broad infant-seasonal protection with a single dose.¹ Maternal RSVpreF vaccination in pregnancy reduced severe RSV-associated LRTI in infants in a large randomized trial, consistent with transplacental antibody protection during early infancy.²

Operationally, selection is often driven by timing (gestational window vs newborn/infant visit), local supply, and care access. For high-risk infants (eg, significant prematurity or chronic cardiopulmonary disease), clinicians should align prophylaxis with specialty guidance and local epidemiology, prioritizing timely administration before peak community transmission.^1,2

When should clinicians start antivirals for children with influenza, and which patients should be prioritized?

According to the American Academy of Pediatrics (AAP) 2025-2026 influenza policy statement, the cornerstone of influenza prevention in children is annual vaccination for all children 6 months of age and older without contraindications, using any licensed age-appropriate vaccine and initiating vaccination as soon as available in the season to maximize protection and reduce morbidity, hospitalization, and community transmission.³

For antiviral therapy, the AAP recommends starting an effective agent (eg, oseltamivir) as early as possible in children with suspected or confirmed influenza who are hospitalized; have severe, complicated, or progressive disease; or have underlying high-risk medical conditions that heighten the risk of complications. Early antiviral initiation improves clinical outcomes regardless of symptom duration.³

In the outpatient setting, antiviral treatment is also recommended for children with confirmed or suspected influenza who are at high risk of complications (eg, age < 2 years, chronic cardiac or pulmonary disease, neurologic conditions, immunosuppression) even when beyond the typical 48-hour window, and may be considered for other symptomatic children in some clinical scenarios. Clinicians should individualize decisions based on severity, risk status, and local influenza activity.³

How can clinicians balance diagnostic testing and antibiotic stewardship for pediatric community-acquired pneumonia?

For otherwise healthy, immunized children with mild to moderate community-acquired pneumonia (CAP), stewardship starts with targeted testing and narrow-spectrum therapy when bacterial infection is likely. Evidence-based pediatric CAP guidance prioritizes:

1. Clinical assessment for severity and need for hospitalization;
2. Limiting routine chest radiography and broad diagnostic panels in uncomplicated outpatient CAP; and
3. Using amoxicillin as first-line therapy for suspected typical bacterial CAP, reserving broader agents for specific indications (eg, β-lactam allergy, complicated pneumonia, or local resistance concerns).⁴

Antibiotics should be withheld when a viral syndrome is strongly supported clinically and no bacterial features are present, and therapy should be reassessed at 48 to 72 hours for clinical response, narrowing or discontinuing when appropriate.⁴ This approach reduces unnecessary exposure, supports resistance mitigation, and standardizes care without compromising outcomes in typical outpatient presentations.⁴

What are the key clinical actions after a suspected measles exposure in a child or in a healthcare setting?

Measles is highly contagious; rapid containment hinges on immunity verification, prompt post-exposure prophylaxis (PEP) when indicated, and infection-control escalation. A concise clinical approach is⁵:

1. Confirm exposure window and assess evidence of immunity;
2. For susceptible contacts, consider the measles, mumps, and rubella vaccine (MMR) as PEP when given promptly (within 72 hours of exposure) and immunoglobulin for those at highest risk or when vaccine is contraindicated; and
3. Implement immediate airborne isolation for suspected cases and notify public health.

In an outbreak setting, both MMR and immunoglobulin PEP have shown effectiveness, supporting time-sensitive deployment based on patient risk and exposure timing.⁶ Contemporary clinical summaries emphasize that declining vaccine coverage has increased outbreak risk and that rapid identification and isolation are central to limiting secondary transmission.⁷

Clinicians should also use every exposure encounter to address vaccination gaps and reinforce community protection via high MMR coverage.^5-7

What should clinicians prioritize for acute gastroenteritis (norovirus) management and healthcare burden awareness in children?

Norovirus is the leading cause of medically attended acute gastroenteritis in US children younger than 5 years, accounting for approximately 20% to 22% of all pediatric acute gastroenteritis visits across inpatient, emergency department, and outpatient settings.⁸ Active, population-based surveillance demonstrates that norovirus is responsible annually for an estimated 14,000 hospitalizations, 281,000 emergency department visits, and 627,000 outpatient visits, totaling nearly 1 million healthcare encounters and more than $273 million in direct medical costs each year.⁸

Clinically, norovirus infection is characterized by abrupt onset of vomiting and diarrhea, typically lasting 1 to 3 days, with the highest rates of medically attended disease occurring in children aged 6 to 18 months.⁸ Although hospitalizations occur, the majority of cases are managed in emergency and outpatient settings, underscoring the importance of early assessment of hydration status and supportive management.⁸

Following the widespread adoption of rotavirus vaccination, norovirus has surpassed rotavirus as the dominant viral cause of pediatric gastroenteritis in the US, with disease burden remaining stable across seasons and driven largely by genogroup II, genotype 4 (GII.4) strains.⁸ Recognition of norovirus as a primary etiology of pediatric gastroenteritis is essential for accurate diagnosis, appropriate management, and public health planning.⁸

References

1. Hammitt LL, Dagan R, Yuan Y, et al. Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med. 2022;386(9):837-846. doi:10.1056/NEJMoa2110275
2. Kampmann B, Madhi SA, Munjal I, et al. Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480
3. Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2025-2026: Policy Statement. Pediatrics. 2025;156(6):e2025073620. doi:10.1542/peds.2025-073620
4. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-e76. doi:10.1093/cid/cir531
5. Centers for Disease Control and Prevention. Measles vaccine recommendations. Published September 20, 2024. https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html
6. Arciuolo RJ, Jablonski RR, Zucker JR, Rosen JB. Effectiveness of measles vaccination and immune globulin post-exposure prophylaxis in an outbreak setting-New York City, 2013. Clin Infect Dis. 2017;65(11):1843-1847. doi:10.1093/cid/cix639
7. Stoneman EK. Measles. JAMA. Published online August 14, 2025. doi:10.1001/jama.2025.14210
8. Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in U.S. children. N Engl J Med. 2013;368(12):1121-1130. doi:10.1056/NEJMsa1206589