Should Your Child Get A Flu Shot?

If your child is under age 5, he or she should definitely get a flu shot. And you probably should, too.
  “Everyone should consider getting a flu shot, because there’s no downside to it,” says Dr. Cliff Nerwen, medical director, division of general pediatrics at Schneider Children’s Hospital/North Shore LIJ Health System.
  According to the National Institute for Allergies and Infectious Diseases, children are two to three times more likely to come down with the flu.  Families with school age children have more infections because schools can be a breeding ground for the virus to attack and spread.  Some viruses can live up to two hours on surfaces like cafeteria tables, desks and doorknobs.
 And when kids get the flu, they are likely to be a lot sicker than adults, probably because they do not have as much natural immunity.

Why hesitate?
   The flu vaccine has been used effectively for decades. There is no flu vaccine shortage predicted for this year.
  While the adult formulations of the flu vaccine often contain thimerosal, most of the childhood formulations, especially those for children under 3 years of age, are thimerosal-free.
   So why do parents hesitate getting a flu shot for their child, or possibly themselves?
  “There are a lot of misconceptions about the vaccine,” says Dr. Nerwen.  “Your arm may be swollen or tender after you get the shot.  But this is temporary.  You don’t get the flu from the shot, and you don't get a cold from the vaccine.  The flu shot will not make you sick.”  The CDC actually recommends the shot for expectant moms at any stage of their pregnancy, and it is declared safe for breastfeeding moms.
   Some people may experience nausea, lethargy, headache, muscle aches or chills after the shot. But again, these are mild and temporary.

The flu shot A list
   While the shot cannot be given to anyone under 6 months of age, anyone living with an infant (and this would include a nanny or caregiver) is urged to get the shot in order to avoid passing the flu onto a baby.  Dr. Nerwen extends this recommendation to include any households with children under age 5.
   And there are certain groups considered high-risk for the flu. If you fall into one of these categories, you should receive the shot:
—health care workers
—children aged 6 months-5 years
—pregnant women
—people aged 50 and over
—anyone over age 5 with certain chronic medical conditions, like lung and respiratory diseases (including asthma), Reye syndrome, blood diseases like sickle cell, diabetes and heart disease.
   According to the American Academy of Pediatrics (AAP), some studies show that smokers are more likely to get the flu and that more smokers die from the flu than non-smokers; the AAP urges all smokers to get a flu shot.   
   Flu shots are usually given in October and November, but it’s never too late to get one during flu season.  Keep in mind that it takes two to four weeks for the vaccine to become effective.

How many shots for kids?
  Dr. Nerwen acknowledges that the number of flu shots can be confusing.   Should your child receive one or two shots?
  “The bottom line is that any child under 9 who is receiving the flu shot for the first time this year should receive two doses, four weeks apart. (Subsequently during any future season, only one dose will be required for that child,” Dr. Nerwen explains).  “Vaccination,” he adds, “should begin as soon as the vaccine becomes available, which is usually at the end of October.”   
  The AAP has alerted pediatrician members that their vaccine supplies may arrive in November and into December; call your pediatrician to find out when his/her supply will be available. January and February are the worst flu months, but flu season can actually last till May, which is why doctors advise getting the shot early, but also when you can.
   “If your child (under 9) got just one dose last year, catch them up this year with two,” Dr. Nerwen advises.

Egg allergy warning
   While stressing that the vaccine is safe, Dr. Nerwen adds that there is one caveat:  Because the vaccine is processed with some egg components, “Anyone with a true, documented egg allergy should not get the vaccine.”

Vaccine alternatives
   For these children and adults (and others who are at high-risk for serious complications from the vaccine), two anti-viral medications are available: Tamiflu and Relenza.  Tamiflu, available in liquid and capsules, is approved for ages one and up; Relenza, which is inhaled, is approved for ages 5 and up.  According to the CDC, when used to prevent the flu, anti-viral drugs are 70 to 90 percent effective.
  However, these drugs are used as the second line of defense — for people who cannot receive the flu shot.

What about the nasal spray flu vaccine?

   FluMist, sprayed into the nose, is approved for ages 2-49 years.  Unlike the flu shot, which is made with dead components, the nasal spray has weakened but live flu virus components.  These will not cause the flu, but FluMist should not be taken by pregnant women, anyone with asthma because wheezing can be a side effect, and, again, anyone allergic to eggs.
   Says Dr. Nerwen: “The nasal spray vaccine is as effective as the injectable vaccine and we ought to use it more often. However, if a child requires two flu doses this season and FluMist is used, unlike the injectable vaccine, the time period between doses needs to be six weeks (as opposed to four for the injections).”

Treating the flu

   Treatment beginning as early as 12 hours after onset of flu symptoms has the greatest impact.  If you suspect the flu, get to your doctor right away.

   “The anti-viral medications are only effective if used at the earliest signs of the beginning of the illness, which is very difficult to distinguish from the multitude of other winter-time viral illnesses,” points out Dr. Nerwen. “They do not ‘cure’ the patient of the flu, but can shorten the course of the illness.  Most pediatricians do not routinely utilize them.”
   And if that early time frame is missed, as it will be in most people, Dr. Nerwen says to keep recovery simple: “Fluids, fluids, fluids and more fluids!  I discourage the use of over-the-counter cough/cold medications.  They are not helpful and can be harmful.” (See accompanying article, “FDA moves on pediatric cough & cold products”).

A cold or the flu?
   Flu symptoms can include high fever, severe headache, muscle and body aches, exhaustion, and dry cough.  Kids can also have additional symptoms like nausea, vomiting and diarrhea.
   But when is the flu not the flu?  Check out the Cold vs. Flu Screening Quiz on’s Pediatrics site.


   Manhattan resident Richard Kanowitz, president of Families Fighting Flu, lost his 4-year-old daughter to influenza in 2004.  Now he is working with Weekly Reader in a new educational campaign, Spread the Word — NOT the Flu! 

   This program provides teacher packets to schools around the country to help teachers give lessons on flu prevention.  Kids in grades 3-8 can create a public service announcement to help educate others about not spreading the flu.  Winners  can get a laptop or college scholarship. 
 Get more info at