Main decision tree
Influenza: one dose or two this season?
At a glance
- Every child 6 months and older needs a flu vaccine every season.
- Children 6 months–8 years need 2 doses, at least 4 weeks apart, unless they had at least 2 flu doses in total before July 1 of this season.
- The earlier doses do not have to be in the same or consecutive seasons. From 9 years, 1 dose is enough.
- A child who turns 9 between dose 1 and dose 2 still gets dose 2.
- The nasal spray (LAIV, FluMist) is for healthy people aged 2–49; it is not for pregnancy, immunocompromise, aspirin therapy, or 2–4-year-olds with asthma or recent wheeze.
- Egg allergy is not a reason to avoid any flu vaccine, and needs no extra precautions.
- In pregnancy, the flu shot is safe at any stage and protects the baby for the first months; the nasal spray is not used.
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Routine childhood vaccine schedule (AAP 2026) — schedule graph
How many doses this season
| Age now | Flu doses before July 1 of this season | Doses this season |
|---|---|---|
| 6 months–8 years | Fewer than 2, or unknown | 2 doses, at least 4 weeks apart |
| 6 months–8 years | 2 or more (any seasons) | 1 dose |
| 9 years and older | Any | 1 dose |
Shot or nasal spray
- Flu shots (inactivated or recombinant vaccine) can be used from 6 months, depending on the product, and in pregnancy.
- The nasal spray (LAIV, FluMist) is a weakened live vaccine for healthy, non-pregnant people aged 2–49.
- Do not use the nasal spray with immunocompromise, aspirin or salicylate therapy, pregnancy, a cochlear implant, a CSF leak, or no working spleen.
- Do not use it in 2–4-year-olds with asthma or wheezing in the past 12 months; asthma from 5 years is a precaution.
- Do not use it after oseltamivir or zanamivir in the past 48 hours, peramivir in the past 5 days, or baloxavir in the past 17 days.
- People who care for someone severely immunocompromised in protective isolation (for example after a stem cell transplant) should get a shot instead.
- All US flu vaccines are now trivalent; none is preferred over another for healthy children.
Who should not get it, or should wait
- Do not give a flu vaccine after anaphylaxis to a previous dose of any flu vaccine, or to a vaccine component other than egg.
- Egg allergy of any severity is not a contraindication; any age-appropriate flu vaccine can be given with routine observation.
- Guillain-Barré syndrome within 6 weeks of a previous flu vaccine is a precaution; discuss before giving another.
- A moderate or severe acute illness is a reason to delay, not to skip. A mild cold is not.
Side effects
- Shot: soreness at the site, mild fever, aches or tiredness for a day or two.
- Nasal spray: runny nose, congestion, mild fever or sore throat.
- The flu shot cannot cause flu; it contains no live virus.
- Serious allergic reactions are very rare.
Common questions
Why do some children need 2 flu shots?
Children 6 months–8 years who have not had at least 2 flu doses before need a first dose to prime the immune system and a second, at least 4 weeks later, to be protected. After that, 1 dose a year is enough.
When should my child get the flu vaccine?
As soon as it is available, ideally by the end of October. Children who need 2 doses should start early. Vaccination is still worthwhile later in the season.
Can a child with egg allergy get the flu vaccine?
Yes. Any flu vaccine suitable for the child's age can be given, with no extra precautions beyond those for any vaccine.
Is the nasal spray flu vaccine OK for my child?
For most healthy children 2 years and older, yes. It is not used in children with a weak immune system, those on aspirin, or 2–4-year-olds with asthma or wheezing in the past year.
Can the flu vaccine be given with other vaccines?
Yes. Flu vaccines can be given at the same visit as other childhood vaccines, including COVID-19 vaccines.
Sources
- CDC: Interim clinical considerations for seasonal influenza vaccines, 2026–2027
- CDC: Clinical considerations for influenza vaccination
- CDC: Child and adolescent immunization schedule
- AAP: Immunization schedule (aap.org)
Written for Pedemy in our own words from the sources above; checked October 2026. For education only, not medical advice. Pedemy is independent and not affiliated with or endorsed by the organizations cited.