Children & Influenza (Flu)
Children younger than 5 years old–especially those younger than 2– are at high risk of developing serious flu-related complications. A flu vaccine offers the best defense against flu and its potentially serious consequences and can also reduce the spread of flu to others. Getting vaccinated has been shown to reduce flu illnesses, doctor’s visits, missed work and school days, and reduce the risk of flu-related hospitalization and death in children. Information on this page summarizes vaccine recommendations for children. Visit this page to learn more about vaccine benefits.
Flu is more dangerous than the common cold for children. Each year flu places a large burden on the health and well-being of children and their families.
Flu illness is more dangerous than the common cold for children. Each year, millions of children get sick with seasonal flu; thousands of children are hospitalized, and some children die from flu. Children commonly need medical care because of flu, especially children younger than 5 years old.
- Complications from flu among children in this age group can include:
- Pneumonia: an illness where the lungs get infected and inflamed
- Dehydration: when a child’s body loses too much water and salts, often because fluid losses are greater than from fluid intake)
- Worsening of long-term medical problems like heart disease or asthma
- Brain dysfunction such as encephalopathy
- Sinus problems and ear infections
- In rare cases, flu complications can lead to death.
- Flu seasons vary in severity, however every year children are at risk
- CDC estimates that since 2010, flu-related hospitalizations among children younger than 5 years old have 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 to 187 deaths. Even though the reported number of deaths during the 2017-2018 flu season was 187, CDC’s mathematical models that account for the underreporting of flu-related deaths in children estimate the actual number was closer to 600. Information about pediatric deaths since the 2004-2005 flu season is available in the interactive pediatric death web application.
Note: See Frequently Asked Flu Questions 2019-2020 Influenza Season for flu and flu vaccine information specific to the current flu season.
The best way to prevent flu is with a flu vaccine. CDC recommends that everyone 6 months of age and older get a seasonal flu vaccine each year by the end of October. However, as long as flu viruses are circulating, vaccination should continue throughout flu season, even in January or later. 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 of developing complications from flu illness, and adults who are close contacts of those children.
Flu vaccines are updated each season as needed to protect against the influenza viruses that research indicates will be most common during the upcoming season. (See Vaccine Virus Selection for this season’s vaccine composition.) The 2019-2020 vaccine has been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination sets in after about two weeks.
Children 6 months and older should get an annual flu vaccine. For the 2019-2020 flu season, CDC recommends annual influenza vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine.
- Injectable influenza vaccine (IIV) is given as an injection (with a needle) and is approved for use in people 6 months and older.
- Live inactivated influenza vaccine (LAIV) is given as a nasal spray and is approved for use in people 2 through 49 years old. However, there is a precaution against the use of nasal spray flu vaccine (LAIV) in people with certain underlying medical conditions. More information about the nasal spray flu vaccine can be found here.
Your child’s health care provider will know which vaccines are right for your child.
For more information on the different types of flu vaccines available visit CDC’s Different Types of Flu Vaccines page.
When Should Children get a Flu Vaccine
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. However, getting vaccinated later can still be protective, as long as flu viruses are circulating. While seasonal flu outbreaks can happen as early as October, during most seasons flu activity peaks between December and February. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against flu virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.
- Some children 6 months through 8 years of age require two doses of flu vaccine for adequate protection from flu. Children in this age group 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—spaced at least 4 weeks apart. Your child’s health care provider can tell you if your child needs two doses.
- 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.
Other Preventive Actions
In addition to getting a flu shot, children and caregivers of young children, should take the same everyday preventive actions CDC recommends for everyone, including covering coughs, washing hands often, and avoiding people who are sick.
Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, and fatigue. Some people may also have vomiting and diarrhea, which more common in children than adults. People may be infected with flu and have respiratory symptoms without a fever.
More information on when to seek emergency care is available online.
Your child’s health care provider can help decide whether your child should take antiviral drugs if they become sick with flu this season. Antiviral drugs for children come in the form of pills, liquid, inhaled powder, or intravenous solution. They fight flu by keeping flu viruses from reproducing in the body. Antiviral drugs must be prescribed by a doctor — they are not available over-the-counter.
More information on children and flu antiviral drugs is available online.
People experiencing these warning signs should obtain medical care right away.
- Fast breathing or trouble breathing
- Bluish lips or face
- Ribs pulling in with each breath
- Chest pain
- Severe muscle pain (child refuses to walk)
- Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
- Not alert or interacting when awake
- Fever above 104°F
- In children less than 12 weeks, any fever
- Fever or cough that improve but then return or worsen
- Worsening of chronic medical conditions
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest or abdomen
- Persistent dizziness, confusion, inability to arouse
- Not urinating
- Severe muscle pain
- Severe weakness or unsteadiness
- Fever or cough that improve but then return or worsen
- Worsening of chronic medical conditions
These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.
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 these children is for their mother to get a flu shot during pregnancy and for people around them to get vaccinated, as well. A flu shot given during pregnancy has been shown to not only protect the mother from flu, but also to help protect the baby from flu infection for several months after birth, before he or she is old enough to be 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. Even children in this age group who are otherwise healthy are at high risk simply because of their age. Additionally, children 2 years of age up to their 5th birthday 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 flu each year. Vaccinating young children, their families, and other caregivers can also help protect them from getting sick.
- American Indian and Alaskan Native children
These children are more likely to have severe flu illness that results in hospitalization or death.4,5
- Children aged 6 months old through 18 years old with chronic health problems, including:
- Asthma and other chronic lung diseases (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
- Neurologic and neurodevelopment 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
- 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)
- Children who are taking aspirin or salicylate-containing medicines
- Extreme obesity, which has been associated with severe flu illness in some studies of adults, may also be a risk factor for children. Childhood obesity is defined as a body mass index (BMI) at or above the 95th percentile, for age and sex.
Additional Resources for Parents and Caregivers
- Figure. Influenza vaccine dosing algorithm for children aged 6 months through 8 years
- 2018-19 Summary of Flu Vaccine Recommendations
- CDC Reports About 90 Percent of Children Who Died From Flu This Season Not Vaccinated March 22, 2013
- Children with Neurologic Disorders at High Risk of Death from Flu August 29, 2012
- CDC Report Details Influenza Prevention and Treatment for Children and Teens September 15, 2011
1CDC Report: CDC Influenza Vaccine Program Impact Report 2015-2016
2Study: Influenza and Other Respiratory Virus–Related Emergency Department Visits Among Young Children.external icon Pediatrics. 2006
3Study: The Underrecognized Burden of Influenza in Young Children.external icon New England Journal of Medicine. 2006
4MMWR: Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives — 12 States, 2009
5MMWR: Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010