Children, the Flu, and the Flu Vaccine

Children, especially those younger than 5 years, are at higher risk for serious flu-related complications. The flu vaccine offers the best defense against getting the flu and spreading it to others. Getting vaccinated can reduce flu illnesses, doctor’s visits, missed work and school days, and prevent flu-related hospitalizations and deaths in children. Information on this page summarizes vaccine recommendations for children. Visit this page to learn more about vaccine benefits.

Note: See Frequently Asked Flu Questions 2017-2018 Influenza Season for flu and flu vaccine information specific to the current flu season.

Influenza is dangerous for children

Influenza (“the flu”) is more dangerous than the common cold for children. Each year, millions of children get sick with seasonal influenza; thousands of children are hospitalized and some children die from flu.

Children commonly need medical care because of influenza, especially before they turn 5 years old.
Children younger than 5 years and especially those younger than 2 years are at high risk of serious influenza complications.
Children of any age with chronic health problems like asthma, diabetes and disorders of the brain or nervous system also are at high risk of serious flu complications.
Flu seasons vary in severity:
- CDC estimates that since 2010, flu-related hospitalizations among children younger than 5 years ranged from 7,000 to 26,000 in the United States.
- While relatively rare, some children die from flu each year. Since 2004-2005, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 deaths to 171 deaths. Information about pediatric deaths since the 2004-2005 flu season is available in the interactive pediatric death web application.

The single best way to protect your children from the flu is to get them vaccinated each year.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called “trivalent” vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. In addition, there are flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same three viruses as the trivalent vaccine and an additional B virus.

What kinds of flu vaccines are available for children?

Influenza vaccine options for the 2017-2018 season are listed in “TABLE: Influenza vaccines — United States, 2017–2018 influenza season. Different products are approved for different age groups, including children as young as 6 months of age.

Note that while there is a quadrivalent nasal spray vaccine that is FDA approved for the U.S. market, ACIP and CDC recommend that nasal spray vaccine not be used during the 2017-2018 season because of concerns about how well it works.

Your child’s health care provider will know which vaccines are right for your child.

CDC recommends that everyone 6 months of age and older get a seasonal flu vaccine.
Keep in mind that vaccination is especially important for certain people who are high risk or who are in close contact with high risk persons. This includes children at high risk for developing complications from influenza illness, and adults who are close contacts of those children.

For the complete list of those at high risk, visit People at High Risk of Developing Flu–Related Complications.

There are special vaccination instructions for children aged 6 months through 8 years of age

Some children 6 months through 8 years of age require two doses of influenza vaccine. Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine, should get two doses of vaccine this season. All children who have previously gotten two doses of vaccine (at any time) only need one dose of vaccine this season. The first dose should be given as soon as vaccine becomes available.

The second dose should be given at least 28 days after the first dose. The first dose “primes” the immune system; the second dose provides immune protection. Children who only get one dose but need two doses can have reduced or no protection from a single dose of flu vaccine.

If your child needs the two doses, begin the process early. This will ensure that your child is protected before influenza starts circulating in your community.

Be sure to get your child a second dose if he or she needs one. It usually takes about two weeks after the second dose for protection to begin.

Recommendations on the control and prevention of influenza are published annually, in late summer or early fall. Existing recommendations are available at Seasonal Influenza Vaccination Resources for Health Professionals.

Some children are at especially high risk

Children at greatest risk of serious flu-related complications include the following:

Children younger than 6 months old
These children are too young to be vaccinated. The best way to protect them is to make sure people around them are vaccinated.
Children aged 6 months up to their 5th birthday
Since 2010, CDC estimates that flu-related hospitalizations among children younger than 5 years ranged from 7,000 to 26,000 in the United States. Even children in this age group who are otherwise healthy are at risk simply because of their age. Additionally, children 2 years of age up to their 5thbirthday are more likely than healthy older children to be taken to a doctor, an urgent care center, or the emergency room because of flu1,2,3. To protect their health, all children 6 months and older should be vaccinated against the flu each year. Vaccinating young children, their families, and other caregivers can also help protect them from getting sick.
1CDC Influenza Vaccine Program Impact Report 2015-2016
2Bourgeois F, Valim C, Wei J, et al. Influenza and Other Respiratory Virus–Related Emergency Department Visits Among Young Children. Pediatrics 2006; Volume 118 /Issue 1
3Poehling K, Edwards K, Weinberg G, et al. The Underrecognized Burden of Influenza in Young Children. The New England Journal of Medicine 2006; 355:31-4
American Indian and Alaskan Native children
These children are more likely to have severe flu illness that results in hospitalization or death.4,5
4CDC. Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaskan Natives — 12 States, 2009. MMWR. 2009;58(48);1341-1344.
5CDC. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010; 59(No.RR-8).
Children aged 6 months through 18 years with chronic health problems, including:
- Asthma
- Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
- Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
- Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
- Blood disorders (such as sickle cell disease)
- Endocrine disorders (such as diabetes mellitus)
- Kidney disorders
- Liver disorders
- Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
- Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids); and
- Children who are receiving long-term aspirin therapy

Children should be vaccinated every flu season

Children should be vaccinated every flu season for the best protection against flu. For children who will need two doses of flu vaccine, the first dose should be given as early in the season as possible. For other children, it is good practice to get them vaccinated by the end of October, if possible. However, getting vaccinated later can still be protective, as long as flu viruses are circulating. While seasonal influenza outbreaks can happen as early as October, most of the time influenza activity peaks between December and February. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.