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The Flu Shot & Kids

If you're thinking about skipping flu vaccination for your family this year, your child has probably never had influenza -- which can leave her coughing, feverish, and completely wiped out for a whole week. "Unfortunately, many parents consider the flu to be nothing more than a slightly nastier version of a cold. It's actually a very serious, potentially fatal illness," says Parents advisor Neal Halsey, MD, director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, in Baltimore. Complications of the flu include pneumonia, antibiotic-resistant staph infections, and ear and sinus infections. Amazingly, only 18 percent of children ages 6 months to 2 years are vaccinated -- despite the fact that an estimated 20,000 children under the age of five with influenza need to be hospitalized each year, according to the Centers for Disease Control and Prevention (CDC). Kids who have a chronic medical condition like asthma or diabetes are also at particular risk; they are five times more likely to be hospitalized than healthier children.

The CDC now recommends that all children ages 6 months up to their 19th birthday get a seasonal flu vaccine. And if there's an infant in your family, it's important that all family members and caregivers be immunized.

Taking your child to the pediatrician to get yet another shot is no fun, but neither is nursing a hacking, cranky kid or spending time at the hospital. Here's what you need to know about this important vaccine.

It's not too late.
Most people get immunized as soon as the vaccine is available in October or November, but your child can benefit from getting the shot as late as April. "Last year's influenza season started off mild and got worse. It's not uncommon to still have flu strains circulating throughout the spring," says Kathleen Gutierrez, MD, a pediatric-infectious-disease expert at Lucile Packard Children's Hospital at Stanford, in Palo Alto, California. Keep in mind, though, that your child's immune system needs two to four weeks to build up protective antibodies, so he could still get sick if he's exposed to an influenza virus soon after he's vaccinated.

You might need two appointments.
If your child is younger than 9 and getting the flu vaccine for the first time, she'll need another dose within four to six weeks. This two-step process gives her immature immune system time to respond.

The shot isn't your family's only option.
Your child may be able to get misted too: A FluMist nasal-spray vaccine was approved in 2008 for use by people two years to 49 years (but not pregnant women). In fact, a study in the New England Journal of Medicine found that FluMist was twice as effective as the shot in children under 5. But children of any age who have asthma or recurrent wheezing problems shouldn't use the nasal spray because it may aggravate breathing difficulties. Some insurance companies may only cover the shot.

Your child is not going to get sick from the vaccine.
The nasal-spray vaccine is made with live, but extremely weak, influenza strains that won't cause the illness. Nevertheless, some children develop mild flulike symptoms within 48 hours of getting either type of vaccine. "These reactions are actually a good sign that your child's body is busy building flu-fighting antibodies," explains Susan Rehm, MD, medical director of the National Foundation for Infectious Diseases. Any side effects should subside within a day or two.

Studies show the vaccine won't cause autism.
The flu shot is the only immunization given to children that still may contain small amounts of thimerosal, a mercury-based preservative that some claim causes autism. However, numerous studies, including one published in the New England Journal of Medicine in September by researchers at the CDC, have found no association between vaccines containing thimerosal and autism. Nevertheless, most pediatricians now offer preservative-free shots for young patients whose parents request them. If your child is older than 2, you can also opt for the nasal spray, which doesn't contain thimerosal.

Pregnant women need protection too.
The American College of Obstetricians and Gynecologists and the CDC recommend that all expectant moms get the flu shot (the nasal spray isn't approved for use in pregnancy) because they're at higher risk of suffering complications of the flu such as pneumonia and even miscarriage. Getting vaccinated during pregnancy may also give your baby's immune system a boost: One study found that babies born to mothers who had received flu shots during their last trimester had a lower rate of influenza during their first six months of life. Breastfeeding moms can be vaccinated and may pass along virus-fighting antibodies to their infants, and the CDC suggests that nursing mothers who've had the shot breastfeed their their infants often as a result.

Kids may qualify for free flu vaccines.
Your child can get a free flu vaccine through the CDC's Vaccines for Children Program if he's Native American, eligible for Medicaid, or without health insurance. He might also be able to get one if your family's health insurance doesn't cover influenza vaccines. For more information, visit cdc.gov/vaccines/programs or contact your state's health and immunization department.

Day 1
An unvaccinated 4-year-old gets sneezed on at preschool.

Day 4
He has a fever of 103 F., is too exhausted to play, and complains that his head hurts. Assuming there's not much she can do if he has the flu, his mom makes him comfy on the couch and gives him lots of liquids and chicken soup.

Day 5
The fever is down to 100 F., but he's coughing up greenish-yellow phlegm, his body aches, and he has loose stools.

Day 8
His cough is better, but he's very congested and isn't eating or drinking much.

Day 9
His mom takes him to an urgent-care facility, where he tests positive for influenza and is given IV fluids for dehydration and antibiotics for an ear infection brought on by the flu.

Day 12
He's finally feeling well enough to play with his big sister, but he gets tired easily. Next year he's definitely getting the flu vaccine.

The vaccine is 70 to 90 percent effective in warding off the three influenza virus strains that experts predict will be likely to circulate in a given year. However, strains can change. If your vaccinated or unvaccinated child develops flu symptoms -- a fever, chills, muscle aches, headache, extreme fatigue, runny nose, sore throat, and a hacking cough -- get him to the doctor quickly. A rapid flu test can determine in about 30 minutes whether it's the flu. If it is, taking an antiviral drug can reduce the severity of the illness and shorten its duration by at least a day or two. To be effective, treatment must begin within 48 hours of the onset of symptoms. Antiviral drugs may be particularly helpful for kids with underlying conditions that might put them at higher risk for severe influenza. Children older than 1 year can take the liquid drug Tamiflu; kids 7 and up can take Relenza, a spray that's inhaled through the mouth. Using an antiviral drug also reduces the odds that other family members will get sick. Since 1999, more than 200 children in Japan who took Tamiflu have experienced psychiatric side effects including hallucinations, and 16 died. It is not clear whether these symptoms were due to the medication or to the flu itself, so the FDA advises monitoring the behavior of kids who are taking Tamiflu.


Copyright © 2007. Used with permission from the December 2007 issue of Parents magazine.

Updated October 2009



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