AAP Flu Vaccine Guidance for Children

Which Children Should Receive an Influenza Vaccine?

Influenza can cause more than fever, coughing, and fatigue in children. It can lead to pneumonia, dehydration, worsening asthma, neurologic complications, hospitalization, and, rarely, death. Infants, children with chronic medical conditions, and those with weakened immune systems face particularly high risks, but serious illness can also occur in previously healthy children.

Children younger than 6 months cannot yet receive an influenza vaccine and depend partly on protection from vaccinated family members and vaccination during pregnancy. The AAP and the Centers for Disease Control and Prevention therefore encourage vaccination throughout households, especially when an infant or medically vulnerable child is present.

How Many Flu Vaccine Doses Does a Child Need?

The number of doses depends on age and previous influenza vaccination. Under established CDC and AAP guidance, children aged 6 months through 8 years may need two doses during the same season if they have not previously received enough influenza vaccine doses or if their vaccination history is unknown. The second dose should be administered at least four weeks after the first.

Children who need two doses should begin vaccination early enough to complete the series before influenza circulation intensifies. Missing the preferred early-season window does not necessarily mean it is too late: vaccination can remain beneficial while influenza viruses are circulating. A pediatric clinician can review immunization records and determine the correct schedule.

Which Flu Vaccine Is Appropriate for a Child?

Injectable inactivated influenza vaccines are available for children starting at 6 months of age. The live attenuated nasal-spray vaccine is an option for eligible children aged 2 years and older, but it is unsuitable for some children, including those with certain immune conditions or other medical contraindications. Vaccine availability, age approvals, and individual health needs can guide product selection.

Children with egg allergy can generally receive any otherwise appropriate influenza vaccine, according to current CDC recommendations; additional precautions based solely on egg allergy are not routinely required beyond the standard readiness to recognize and treat an uncommon severe allergic reaction. Common effects such as injection-site soreness, fatigue, or a brief fever are usually mild. Vaccination does not cause influenza, although protection takes time to develop and breakthrough infections can still occur.