At what age should pediatric patients start receiving flu vaccinations?

Age to Start Flu Vaccination in Pediatric Patients

All children should begin receiving annual influenza vaccination at 6 months of age. 1

Universal Recommendation

The American Academy of Pediatrics consistently recommends annual influenza immunization for all children without medical contraindications starting at 6 months of age. 1, 2 This recommendation has remained unchanged across multiple guideline iterations from 2008 through 2024-2025, representing the strongest consensus in pediatric preventive medicine. 1

Any licensed, age-appropriate influenza vaccine can be administered without preference for one product over another. 1

Why 6 Months Is the Starting Age

• Children younger than 6 months cannot receive influenza vaccine because vaccines are not approved or recommended for this age group. 3
• Infants under 6 months must rely on indirect protection through vaccination of household contacts, caregivers, and pregnant mothers. 3, 4
• Children younger than 5 years, especially those under 2 years, face hospitalization rates from influenza comparable to or exceeding elderly adults and other high-risk groups. 5
• Previously healthy children in their first year of life have substantial risk for developing serious influenza disease. 4

Critical Dosing Requirements for First-Time Recipients

Children 6 months through 8 years receiving influenza vaccine for the first time require 2 doses administered at least 4 weeks apart. 1, 3, 6 This is the most common pitfall in pediatric influenza vaccination.

• Both doses should ideally be administered before the end of October to ensure protection before peak influenza activity. 3, 6
• If a child received only 1 dose for the first time in the previous season, they still need 2 doses in the current season. 3
• Children who have previously received 2 or more total lifetime doses of influenza vaccine need only 1 dose annually thereafter. 5, 6

Age-Specific Vaccine Products and Dosing

For children 6 months through 35 months: 3

• Fluzone: either 0.25 mL or 0.5 mL dose
• Afluria: 0.25 mL dose
• Fluarix, FluLaval, Flucelvax: 0.5 mL dose

For children 36 months and older: 3, 5

• All products: 0.5 mL dose
• Live attenuated influenza vaccine (LAIV/nasal spray) becomes an option for healthy children 2 years and older 1, 5

Timing Considerations

• Vaccination should begin as soon as vaccine becomes available each season. 1, 3, 5
• Do not delay vaccination waiting for a "better" vaccine product or "optimal timing." 5, 6
• Continue offering vaccination throughout the entire influenza season, even after community activity has been documented. 5
• For children requiring 2 doses, start vaccination early to allow adequate time for the second dose before peak season. 3, 6

High-Priority Populations Within the 6-Month-and-Older Group

While all children 6 months and older should be vaccinated, certain groups warrant particular emphasis: 1

• Children younger than 5 years (especially under 2 years)
• Children with chronic medical conditions (pulmonary disease, cardiovascular disease, immunosuppression)
• Children with recurrent respiratory infections or asthma

Vaccine Effectiveness and Impact

• Vaccine effectiveness against influenza-associated death in children is 65% overall and 51% in children with underlying conditions. 6
• Up to 80% of influenza-associated pediatric deaths occur in unvaccinated or incompletely vaccinated children. 6
• Influenza vaccination prevented an estimated 116 deaths in children aged 6 months through 17 years during the 2022-2023 season. 6
• Vaccination reduces life-threatening influenza illness by 75% in children. 6

Common Pitfalls to Avoid

Failing to complete the two-dose series in vaccine-naive children under 9 years is the most critical error, as a single dose provides inadequate protection. 3, 5

• Do not assume a child only needs one dose—verify complete vaccination history to determine if they meet the threshold of 2 prior lifetime doses. 5
• Do not use incorrect dosage based on age and specific vaccine product. 3
• Do not delay the second dose beyond 4 weeks, as this may leave the child inadequately protected during peak season. 3
• Do not give LAIV (nasal spray) to children 2-4 years old with a history of recurrent wheezing or any wheezing episode in the previous 12 months. 5