Can the influenza (flu) vaccine be administered intramuscularly (IM) to children?

Intramuscular Influenza Vaccination in Children

Yes, the influenza vaccine can and should be administered intramuscularly to children aged 6 months and older, with specific anatomical sites based on age: the deltoid muscle for older children and the anterolateral thigh for infants and young children. 1

Route of Administration

• Inactivated influenza vaccines (IIV) are administered intramuscularly using needle and syringe for all pediatric age groups. 1
• The only exception to needle-and-syringe administration is Afluria Quadrivalent, which may be given via jet injector, but this is approved only for adults aged 18-64 years—not for children. 1

Anatomical Site Selection by Age

For infants and young children:

• The anterolateral aspect of the thigh is the preferred injection site for infants and young children due to insufficient deltoid muscle mass in this age group. 1, 2, 3

For older children:

• The deltoid muscle is the preferred site for older children (generally those with adequate muscle mass). 1, 2, 3

Injection Technique

• Vaccines should be administered at a 90-degree angle to ensure proper intramuscular placement. 2, 4
• Appropriate needle length must be selected based on patient size and injection site per ACIP General Best Practice Guidelines. 1, 2
• Aspiration is not required before injection because no large blood vessels exist at the recommended injection sites. 2

Dose Volumes for Children

Children aged 6-35 months:

• Dose volume varies by product: either 0.25 mL or 0.5 mL depending on the specific vaccine formulation. 1, 3
• Afluria Quadrivalent: 0.25 mL per dose 1
• Fluzone Quadrivalent: either 0.25 mL or 0.5 mL per dose (no preference) 1
• Fluarix, Flucelvax, and FluLaval Quadrivalent: 0.5 mL per dose 1

Children aged 36 months through 17 years:

• Standard dose is 0.5 mL per dose for all intramuscular IIV products. 1, 3

Critical Pitfalls to Avoid

• Do not administer influenza vaccine in the buttocks due to potential reduced immunogenicity and risk of sciatic nerve injury. 4
• If a smaller dose (e.g., 0.25 mL) is inadvertently given to a child requiring 0.5 mL, administer the remaining volume during the same visit or give a full 0.5 mL dose as soon as the patient returns. 1, 2
• Care must be taken to administer the age-appropriate vaccine at the correct dose volume for each product, as different formulations have different approved volumes for young children. 1

Contraindications

• History of severe allergic reaction to any vaccine component or previous dose of any influenza vaccine is an absolute contraindication. 1, 3
• Moderate or severe acute illness with or without fever is a precaution (but minor illnesses without fever do not contraindicate vaccination). 1, 3
• History of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination is a precaution. 1, 3

Special Considerations for Egg Allergy

• Children with egg allergy may receive any licensed, age-appropriate influenza vaccine. 1, 2
• Those with severe egg reactions (angioedema, respiratory distress, recurrent emesis, or requiring epinephrine) should be vaccinated in a medical setting supervised by a provider able to manage severe allergic reactions. 1, 2