Influenza (flu) is a contagious respiratory disease caused by influenza viruses. Flu can be 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. Annual flu vaccination offers the best protection against flu and its potentially serious complications in children. Parents can help children fight flu by getting themselves and their children vaccinated against flu each year.

Children younger than 5 years old—especially those younger than 2—and children of any age with certain chronic health conditions, like asthma and diabetes, are at higher risk of developing potentially serious flu complications. Because these groups of children are at higher risk, it is especially important that they get a seasonal flu vaccine to help prevent flu, and to reduce their risk of being hospitalized or dying from flu if they do get sick.

While not at higher risk, healthy children 5 years and older can also get very sick from flu, in addition to spreading flu to vulnerable family members like infants younger than 6 months and adults who are 65 years and older or people of any age who have certain chronic health conditions.  It’s important to vaccinate everyone 6 months and older against flu each year to help protect those most at risk.

Influenza (or the ‘flu’) is a respiratory infection caused by influenza virus. A virus is a kind of germ that makes people sick. Sometimes people refer to other illnesses as ‘flu’, but in this document, ‘flu’ is used only as a short form for ‘influenza’.

Influenza outbreaks occur every year, usually between November and April. Because influenza viruses change – often from year to year – immunity to (or protection from) influenza does not last long. That’s why people can catch the flu more than once.

From time to time, there is a major change in the influenza virus such that no one is immune. When this happens, large numbers of people of all ages all around the world become sick with the flu within a few months. This is called an influenza ‘pandemic’. Pandemics have occurred in 1889, 1918, 1957 and 1968. Experts are working to prevent a pandemic the next time there is a major change in the influenza virus.

The flu virus spreads quickly from person to person, especially where there are crowds or where people live, work or study close together. Children are most likely to be infected and are the major spreaders of influenza.

The flu strikes more quickly than a cold, and people who get it feel sicker. While children with colds usually have energy to play and keep up their daily routines, the flu usually keeps them in bed.

Flu can be dangerous for children

Flu illness is more dangerous than the common cold for children. As of 2020, there are approximately 73 million children in the United States. 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.

Some children are at higher risk

Children younger than 5 years old–especially those younger than 2– and children of any age with certain chronic health conditions, are at higher risk of developing potentially serious flu-related complications.

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

1. Children younger than 6 months old
   These children are too young to be vaccinated. The best way to protect these children is for their parents to get a flu shot during pregnancy and (after birth) for people around them to get vaccinated. A flu shot given during pregnancy has been shown to not only protect the pregnant parent 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.
2. Children aged 6 months up to their 5th birthday
   From the 2010-2011 season to the 2019-2020 season, CDC estimates that flu-related hospitalizations among children younger than 5 ranged from 6,000 to 27,000 Even children in this age group who are otherwise healthy are at higher risk simply because of their age. Additionally, children 2 years of age up to their 5^th birthday are more likely than healthy older children to be taken to a doctor, an urgent care center, or the emergency room because of flu^1,2,3. 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.
3. American Indian and Alaskan Native children
   These children are more likely to have severe flu illness that results in hospitalization or death.^4,5
4. 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.

Annual Flu vaccination is especially important for children at higher risk.

The best way to prevent flu is with an annual flu vaccine. CDC recommends that everyone 6 months and older get a seasonal flu vaccine each year, ideally by the end of October. For most people who need only one dose of flu vaccine for the season, September and October are good times to be vaccinated. Some children need two doses of flu vaccine. For those children, it is recommended to get the first dose as soon as vaccine is available—even if this is in July or August—because the second dose needs to be given at least four weeks after the first. Vaccination during July and August also can be considered for children who need only one dose. However, as long as flu viruses are spreading, vaccination should continue throughout flu season, even in January or later. Since it takes about weeks after vaccination for the body to develop antibodies against flu virus infection, it is best to get vaccinated before flu begins spreading in their community. More information on flu vaccination timing is available.

Keep in mind that flu vaccination is especially important for certain people who are higher risk of developing serious flu complications or who are in close contact with people at higher risk. This includes children at higher risk of developing complications from flu illness and adults who are close contacts of those children.

Influenza viruses are found in the nose and throat. Because children touch their noses, eyes and mouths often, put things in their mouths, and touch each other often during play, flu germs spread easily. There is also a lot of contact between parents or caregivers and children: holding hands, picking up, feeding, changing diapers and so on.

• The influenza virus may be spread through droplets in the air. These droplets come from the nose and mouth during coughing or sneezing, travel though the air, and reach the mouths or noses of others who are nearby (within a metre or so).

• A person with the flu transfers the virus to the hands when touching the nose or mouth, wiping the nose, or coughing or sneezing, and may pass the virus directly to others by touching them.

• A person with the flu gets virus on the hands and then touches an object, such as a toy or furniture. Influenza viruses can live for several hours on toys, doorknobs, computer keyboards or other hard surfaces. The virus can be picked up on the hands of others who touch these same objects. People then get infected when they touch their eyes, nose or mouth.

• Caregivers may get the flu virus on their hands and then spread it between children by touching them.

Influenza usually begins with sudden fever, chills and shakes, headache, muscle aches, extreme tiredness, dry cough and sore throat. Loss of appetite is common. People with the flu generally feel very sick and want to stay in bed.

Although children with the flu may have many of the same symptoms as adults, there are some differences:

• Newborns and infants may have a high fever that can’t be explained, and no other signs.

• Young children usually have temperatures over 39.5°C and may have febrile seizures (convulsions).

• Flu is an important cause of croup (an infection of the throat and vocal cords), pneumonia (lung infection) and bronchiolitis (infection of the tiny airways that lead to the lungs) in young children.

• Stomach upsets, vomiting, diarrhea and abdominal (stomach) pain are more common in younger children. Earaches and red eyes are also more common.

• In some cases, muscle swelling can lead to severe leg or back pain.

Most healthy people recover from the flu without any serious problems. Fever and muscle aches usually last only 2 to 4 days, but cough and tiredness may go on for 1 to 2 weeks or more.

In rare cases, influenza may affect the brain, causing prolonged seizures, confusion or unresponsiveness. In rare cases, it may affect the heart. Influenza may also weaken the immune system and lead to bacterial infections of the ear, lung or sinuses.

Influenza is more severe in children under 2 years of age and in children with certain chronic conditions.

People experiencing these warning signs should obtain medical care right away.

In children

• 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
• Seizures
• Fever above 104 degrees Fahrenheit that is not controlled by fever-reducing medicine
• In children less than 12 weeks, any fever
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

In adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• 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.

Contact your doctor or take your child to an emergency department if your child:

• has signs of influenza and has lung or heart disease, has an illness or is taking treatment that affects the immune system, takes acetylsalicylic acid (ASA or Aspirin) regularly for a medical condition or has any other chronic illness requiring regular medical care;

• is less than 3 months old and has a rectal temperature over 38.5°C;

• has trouble breathing when resting, is wheezing, has chest pain when breathing or is coughing up bloody sputum (phlegm or saliva);

• drinks very little fluid and has not urinated at least every 6 h when awake;

• has vomiting for more than 4 h, or has severe diarrhea;

• is constantly irritable and will not calm down;

• is listless, not interested in playing with toys or unusually sleepy; or

• still has a fever and is not feeling better after 5 days or was feeling better and suddenly develops a new fever.

Take your child immediately to a hospital emergency department or call 911 if your child:

• has severe trouble breathing or blue lips;

• is limp or unable to move;

• is hard to wake up or does not respond;

• has a stiff neck;

• seems confused; or

• has a seizure (convulsion/fit).

• Keep your child as comfortable as possible and encourage rest. If he has fever, dress him in lightweight clothing and keep the room temperature around 20°C.

• Offer cool fluids often. Extra fluids are needed to replace those lost in sweat. If your child’s urine is darker than usual, she needs to drink more.

• Your child may not want to eat. Offer small, nutritious meals.

• Monitor your child’s temperature. For pain relief, muscle aches or fever with temperature higher than 38.5°C, use acetaminophen (eg, Tylenol, Tempra and Panadol). Ibuprofen (eg, Advil and Motrin) may be used for children over six months old. Use the dose and schedule recommended on the package or by your doctor or pharmacist. Do not give acetylsalicylic acid (ASA [eg, Aspirin]) or any cold medicine with it, to children or teenagers with influenza because it can lead to brain and liver damage (Reye syndrome).

• ‘Over-the-counter’ cough and cold medicines (which don’t need a doctor’s prescription) should not be given to children younger than 3 years of age unless prescribed by your doctor. Ask your doctor or pharmacist before giving over-the-counter medicines to a child under 12 years of age or anyone who is taking other medicines or has a chronic illness. Read label instructions carefully and do not take more than recommended.

• Coughing helps to clear mucus from the chest. For an older child with a frequent, dry cough that prevents sleeping, a product with dextromethorphan may help, but studies have shown that these products don’t have much benefit. Decongestants and antihistamines won’t stop coughing.

• If an infant is having trouble feeding because of a stuffed nose, use a rubber suction bulb to clear the mucus. Use saline nose drops or saline nose spray if the mucus is very thick. The spray goes well into the nasal passages and may be more effective than the drops.

• A cool mist humidifier will make a child with a stuffed nose more comfortable. Clean and dry the humidifier thoroughly to prevent bacterial or mould contamination. Hot water vaporizers are not recommended because of the risk of burns.

• Medicated nose drops or sprays provide only brief relief and should not be used for more than 2 to 3 days because nasal congestion can actually get worse. These should not be used in children under 6 years of age. Decongestants taken by mouth are not very effective and can cause rapid heartbeat or insomnia in children. Antihistamines are not effective for influenza.

• Influenza cannot be treated with antibiotics. Antibiotics should be used only when children develop bacterial complications, such as ear infection or pneumonia.

• Gargling with warm water will ease a sore throat. For children 3 years or older, sucking on sugarless hard candy or lozenges containing honey, herbs or pectin also helps. Throat lozenges containing medications that numb the throat (dyclonine, benzocaine, hexylresorcinol, menthol and phenol) should not be used by young children because these may affect their ability to swallow.

Antiviral Drugs

While getting an influenza (flu) vaccine each year is recommended by CDC as the first and most important step in protecting against flu, there also are drugs that can treat flu illness. These “flu antiviral drugs” are an important treatment option for children with suspected or confirmed flu.

Antiviral drugs for children come in the form of pills, liquid, inhaled powder, or intravenous (IV) solution. They fight flu by keeping flu viruses from reproducing in the body. Antiviral drugs must be prescribed by a health care provider — they are not available over-the-counter. For treatment, flu antiviral drugs should ideally be started within two days after becoming sick, but children can still benefit when antiviral treatment is started two or more days after becoming sick. Antiviral drugs are especially important for children who are at increased risk for flu complications or who are hospitalized If a child is sick with flu, antiviral drugs offer a safe and effective treatment option.

Flu antiviral drugs only work against influenza viruses — they will not help against other viruses that may cause illness symptoms similar to flu.

Benefits from Antiviral Treatment of Influenza

Flu antiviral drugs can make flu symptoms milder and can shorten duration of illness. Antiviral drugs work best if started soon after getting sick (within two days of symptoms starting). Early treatment of flu with antiviral drugs also has been shown to reduce the incidence of ear infections and the need for antibiotic treatment in children between 1 and 12 years old. Treatment with antiviral drugs also may reduce more serious flu-related complications like pneumonia and hospitalizations. Studies in both adults and children show that treatment of hospitalized patients can be beneficial in preventing respiratory failure and death.

CDC and the American Academy of Pediatrics (AAP) recommend antiviral drugs to treat confirmed or suspected flu in children with severe, complicated, or progressive illness, or who are hospitalized with confirmed or suspected flu, as early as possible. Prompt initiation of antiviral treatment also is recommended for children who have confirmed or suspected flu and who are at increased risk of serious flu complications. Children at increased risk of flu-related complications include children younger than 5 years old (especially those younger than 2 years) and children of any age with certain chronic health conditions like asthma, diabetes, or heart or lung disease.

Antiviral Drugs Approved for Use in Children

There are four flu antiviral drugs approved by the U.S. Food and Drug Administration (FDA) for use in the United States which are recommended by CDC for use in children this flu season:

• Oseltamivir (available as a generic version or under the trade name Tamiflu®) is approved for treatment of flu in children 14 days old and older. Oral oseltamivir comes in the form of pills and liquid. Although not part of the FDA-approved indications, use of oral oseltamivir for treatment of flu in infants younger than 14 days old.
• Zanamivir (trade name Relenza®) is approved for treatment of flu in children 7 years and older. It is not recommended for use in children with underlying respiratory disease, including those with asthma and other chronic lung diseases. Inhaled zanamivir is given via a special inhaler (Diskhaler®).
• Peramivir (trade name Rapivab®) is given intravenously and recommended for use in children 6 months and older.

Baloxavir (trade name Xofluza®) is a pill that is given as a single dose by mouth and is approved for early treatment of flu in children aged 5 to less than 12 years who do not have any chronic medical conditions, and for all children aged 12 and older.

Side Effects of Antiviral Drugs

Side effects vary for each medication. The most common side effects for oseltamivir are nausea and vomiting. Zanamivir can cause difficulty breathing in people with underlying lung disease and peramivir can cause diarrhea. Other less common side effects also have been reported. Your health care provider can give you more information about these drugs.

If Your Child Gets Sick with Flu

Your child’s health care provider can help decide whether your child should take antiviral drugs if they become sick with flu this season. Flu signs and symptoms include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches. It’s important to note that some children with flu will not have a fever.

Does oseltamivir come in a liquid form?

Yes, oseltamivir is produced in a suspension (liquid) form. However, this is a seasonal item and may not always be available in every pharmacy. Sometimes your child’s provider may prescribe oseltamivir capsules for your child.

What can I do if my child cannot swallow capsules?

If your child’s provider prescribes oseltamivir capsules for your child and your child cannot swallow capsules, the prescribed capsules may be opened, mixed with a thick sweetened liquid, and given that way.

What liquids can I use?

A thick, sweetened liquid that masks the flavor of the medicine, such as regular or sugar-free chocolate syrup, can be mixed with the contents of the oseltamivir capsule. You don’t have to use chocolate syrup, but thick, sweet liquids work best at covering up the taste of the medicine. The child should consume the liquid mixture entirely.

If my child can’t swallow capsules, how do I open oseltamivir capsules and mix the medicine?

Pour a small amount (about a spoonful) of the thick, sweetened liquid into a cup or bowl. Carefully open the oseltamivir capsule and pour out all of the powder inside the capsule and mix it into the liquid. The exact amount of liquid used doesn’t matter, as long as the powder inside the capsule is mixed in well. All of the medicine may not dissolve, just be sure it is all well mixed. Use only the prescribed dose.

What will I need to do this?

You will need:

• the prescribed oseltamivir capsule
• a small bowl or cup
• a spoon
• a spoonful of a thick, sweetened liquid, such as regular or sugar-free chocolate syrup

How do I mix the ingredients?

• Pour a small amount (about a spoonful) of the thick, sweetened liquid into a cup or bowl.
• Holding one capsule over the bowl, carefully pull the capsule open and pour the complete contents of the capsule into the bowl.
• Stir the mixture and give the entire dose to the child with a spoon.

Should my child take all of the mixture?

Yes, make sure your child takes all of the medicine mixture.

• Handwashing is the most important way to reduce the spread of flu:

  • Wash your hands after being in direct contact with someone who has a respiratory infection.

  • Wash your own hands and your child’s hands after wiping your child’s nose.

  • Wash your hands after coughing, sneezing or wiping your nose.

  • When water and soap are not available, use premoistened hand wipes or alcohol-based hand rinses. Keep hand rinses out of reach of children because they may be harmful if swallowed.

  • Wash your hands after touching objects handled by someone who has influenza.

• Teach children to cover their noses and mouths with tissues when sneezing or coughing, to put used tissue in a wastebasket immediately, and to wash their hands after wiping their nose or handling tissues.

• If a family member has the flu, clean surfaces (such as toys, bathroom taps and doorknobs) after the ill person has touched them.

• If your child attends daycare, tell the caregiver if you think your child has influenza. Keep your child at home, away from daycare or school, until the fever is gone and she is feeling better. When both parents work outside the home, plan ahead by making arrangements for when your child becomes ill.

Children younger than 5 years old– especially those younger than 2– are at higher risk of developing serious flu-related complications. CDC estimates that from 2010 to 2020, flu-related hospitalizations among children younger than 5 years ranged from between 6,000 to 27,000 per year in the United States. Many more have to go to a doctor, an urgent care center, or the emergency room because of flu.

Complications from flu among children 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 fluid intake),
• worsening of long-term medical problems like heart disease or asthma,
• brain dysfunction,
• sinus problems, and ear infections.

In rare cases, flu complications can lead to death.

Children Younger Than 6 Months Old at Highest Risk

Children younger than 6 months old have the highest risk for being hospitalized from flu compared to children of other ages but are too young to get a flu vaccine. Because flu vaccines are not approved for use in children younger than 6 months old, protecting them from flu is especially important.

Advice on How to Fight Flu for Caregivers of Children Younger than 5 Years Old

1. Take Time to Get a Vaccine
   • A yearly flu vaccine is the first and best way to protect against flu.
   • Flu vaccine has been shown to reduce the risk of flu illness, hospitalization and death in children.
   • If the child you care for is 6 months or older, they should get a flu vaccine each year.
   • As a caregiver to a young child, you should get a flu vaccine, and make sure that other caregivers and all household members aged 6 months and older also get vaccinated each year. By getting vaccinated, you will be less likely to get flu and therefore less likely to spread flu to the child.
2. Take Everyday Preventive Actions
   • Keep yourself and the child in your care away from people who are sick as much as you can.
   • If you get flu symptoms, avoid contact with other people when possible, including the child in your care. Consider arranging for another caregiver to care for the child if possible, so that you don’t make them sick.
   • Cover your nose and mouth with a tissue when you cough or sneeze—throw the tissue away after you use it and wash your hands.
   • Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based hand cleaner.
   • Try not to touch your eyes, nose or mouth. Germs often spread this way.
   • Clean and disinfect frequently touched surfaces, especially when someone is ill.
3. Take Antiviral Drugs to Treat Flu Illness if Your Doctor Prescribes Them
   • Antiviral drugs are available to treat flu in children and adults.
   • Antiviral drugs can make illness milder and shorten illness duration. They also may prevent serious flu complications.
   • Antiviral drugs are different from antibiotics that treat bacterial infections. They are prescription medicines (pills, liquid or an inhaled powder) that are for treatment of flu.
   • Antiviral drugs work best when treatment is started within 2 days of becoming sick with flu, but starting them later can still be helpful, especially if the sick person is very sick with flu or is at higher risk of serious flu complications. Follow your doctor’s instructions for taking or giving these drugs.
   • Treating people who are very sick with flu or who are at higher risk of flu complications with antiviral drugs can mean the difference between having a milder illness versus a very serious illness that could result in a hospital stay.
   • CDC recommends that people at higher risk of serious flu complications, including young children, should be treated with flu antiviral drugs as soon as possible if they get sick with flu.
     • Although all children younger than 5 years old are considered at higher risk for complications from flu, the highest risk is for those younger than 2 years old, with the highest hospitalization and death rates among infants younger than 6 months old.

Advice If You Are Sick with Flu and Care for Children Younger than 5 Years Old

Flu may cause fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Young children also may have vomiting or diarrhea with flu symptoms. It’s important to note that some people with flu may not have a fever. If you live with or care for a young child and you get flu symptoms, follow the precautions below to help prevent the spread of illness to the child or children in your care.

1. Remember How Flu Spreads
   • Flu viruses are thought to spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. People with flu can spread it to others up to about 6 feet away. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching his or her own mouth, nose, or possibly their eyes.
2. Follow These Steps
   • Call your health care professional if you develop flu symptoms; they may prescribe antiviral drugs for flu, depending on factors including your age and overall health and the age and overall health of your young child or children.
   • Try to minimize contact with the child in your care as much as possible, especially if the child in your care is younger than 2 years old or is an older child with a chronic medical condition. They are very vulnerable to flu.
   • Cover your nose and mouth with a tissue when sneezing or coughing, and put your used tissue in a wastebasket, and wash your hands.
   • Before engaging in any activity within about 6 feet of the child in your care (including feeding, changing, rocking, reading to your child) thoroughly wash and dry your hands. See more information about preventing the spread of seasonal flu.
3. Be Watchful to See If Your Child Gets Sick Too
   • Observe the child or children in your care closely for signs and symptoms of respiratory illness. If your child develops a fever* (or feels feverish with chills), cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue, or vomiting and/or diarrhea—contact your child’s health care provider.
   • Flu antiviral drugs can be used to treat flu and are approved for use in children. These drugs are most beneficial when antiviral treatment is started as soon as possible after the illness starts, so it’s important to contact your child’s health care provider as soon as they have flu symptoms.
   • If your child shows any Emergency Warning Signs of flu, seek medical care immediately.

Footnote

* Many authorities use either 100 (37.8 degrees Celsius) or 100.4 F (38.0 degrees Celsius) as a cut-off for fever, but this number can vary depending on factors such as the method of measurement and the age of the person

Children younger than 5 years old–especially those younger than 2–are at higher risk of developing serious flu-related complications. Children of any age with certain chronic health conditions are also at higher risk; during the 2022-2023 flu season, 66 percent of children 0 to 17 years old hospitalized with flu had at least one underlying health condition, such as asthma, neurologic disease, obesity, or immune suppression. More information is available about children at higher risk of potentially serious flu complications.

While not at higher risk, children 5 years and older can spread flu to their higher risk family members, like infants younger than 6 months old and adults who are 65 years and older or people of any age who have certain chronic health conditions. It’s important to vaccinate everyone 6 months and older in your family against flu each year to help protect those most at risk. A flu vaccine offers the best defense against flu and its potentially serious complications and also can reduce the spread of flu to others.

In children, annual flu vaccination has been shown to:

• Reduce flu illnesses, doctor’s visits for flu, and missed school days
• Reduce the risk of flu-related hospitalization and death.

Flu can be dangerous for children

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 from the 2010-2011 season to the 2019-2020 season, flu-related hospitalizations among children younger than 5 years old each flu season have ranged from 6,000 to 27,000 annually in the United States.
  • While relatively rare, some children die from flu each year. From the 2004-2005 season to the 2019-2020 season, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 to 199 deaths. (During the 2009 H1N1 pandemic, 358 flu-related deaths in children were reported to CDC from April 2009 to September 2010.)
  • Importantly, among reported flu-related deaths in children, about 80% occurred in children who were not fully vaccinated.
  • Also of note, even though each flu death in a child is supposed to be reported to CDC, it is likely that not all flu-related deaths in children are captured and that the actual number of deaths is higher. CDC has developed statistical models that account for the underreporting of flu-related deaths in children to estimate the actual number of deaths. During 2019-2020, for example, 199 flu-related deaths in children were reported to CDC, but statistical modeling suggests approximately 434 deaths may have occurred. More information about flu-related deaths in children since the 2004-2005 flu season is available in the FluView Interactive web application.

Vaccination is the best protection against flu

The best way to prevent flu and its potentially serious complications is by getting an annual flu vaccine. Even when flu vaccination does not prevent illness entirely, it has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.

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

Flu vaccines are updated each season to protect against the four influenza viruses that research indicates will be most common during the upcoming season. This season’s flu vaccine has been updated from last season. More information is available on this season’s flu vaccine composition.

Types of flu vaccines for children

CDC recommends annual flu vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine.

There are many vaccine options:

• Flu shots are given as an injection (with a needle) and are approved for use in people 6 months and older. (Indications vary by vaccine.)
• Nasal spray vaccine (also known as the Live attenuated influenza vaccine or LAIV4) is approved for use in non-pregnant, healthy people 2 through 49 years. However, there is a precaution against the use of nasal spray flu vaccine (LAIV) in people with certain underlying medical conditions. More information can be found about the nasal spray flu vaccine.

When Should Children get a Flu Vaccine

Children should be vaccinated every flu season for the best protection against flu. For most people who need only one dose of flu vaccine for the season, September and October are generally good times to be vaccinated. Ideally, everyone 6 months and older should be vaccinated by the end of October. Some children need two doses of flu vaccine. For those children, it is recommended to get the first dose as soon as vaccine is available—even if this is in July or August—because the second dose needs to be given at least four weeks after the first. Vaccination during July and August also can be considered for children who need only one dose. However, getting vaccinated later can still be protective, as long as flu viruses are spreading—even into January or later. Since it takes about two weeks after vaccination for the body to develop antibodies against flu virus infection, it is best to get vaccinated so they are protected before flu begins spreading in their community.

Special vaccination instructions for children aged 6 months through 8 years old

• Some children 6 months to 8 years old need two doses of flu vaccine.
• Children in this age group getting vaccinated for the first time, those who have only previously received one dose of flu vaccine, and whose flu vaccination history is unknown, should get two doses of vaccine this season.
• For those children it is recommended they get the first dose as soon as vaccine is available, because the second dose needs to given at least 4 weeks after the first.
• Your child’s health care provider can tell you if your child needs two doses.

Other Preventive Actions

In addition to getting a flu vaccine, children and caregivers should take the same everyday preventive actions CDC recommends for everyone, including avoiding people who are sick, washing hands often, and covering coughs.