Should Your Child Get a Flu Shot or the Spray?

Kids who want to avoid the needle can safely get the spray, with a few exceptions.

Pediatricians recommend that all children age 6 months and older get vaccinated against the flu. Shots can be a hard sell to most kids, who’ll turn a cold shoulder at the mere mention of a needle, but parents do have another option — the nasal spray vaccine. Is one better than the other? Both shot and spray protect against the flu, but some kids have to stick with the needle for age or health reasons.

Why your child needs to get vaccinated

For most kids who catch it, the flu is nothing more than a few sniffly, achy, feverish days home from school. But sometimes it can turn into more serious diseases, like pneumonia or bronchitis. Kids with chronic health issues such as asthma, diabetes, or immune system problems are especially vulnerable to flu complications, which send 20,000 kids under age 5 to the hospital each year. During the 2014-2015 flu season, 150 children died. Nearly all of them were unvaccinated, and many didn’t have any underlying health issues.

“Flu vaccine is the best way we have to protect children against this virus,” said Henry Bernstein, DO, MHCM, FAAP. “Being immunized with the flu vaccine every year significantly reduces the risk of your child being hospitalized due to flu, and it protects other vulnerable members of your family and community.”

Flu shot — or spray?

When you visit your local pharmacy, pediatrician’s office, or flu clinic to get your child vaccinated, you’ll be offered two options:

The flu shot contains an inactivated virus, and is recommended for kids ages 6 months and up. It comes in a trivalent vaccine, which protects against three virus strains, and a quadrivalent vaccine, which protects against four strains.

The nasal spray contains a live but weakened version of four influenza virus strains. It’s approved for kids ages 2 and up.

If you have a child age 2 or over, you might wonder whether the shot or nasal spray will protect your child best. A few studies, including one published in The New England Journal of Medicine, found that groups of kids who get the spray have fewer cases of flu than groups that receive shots.

Based on these results, for the 2014-2015 season, the Advisory Committee on Immunization Practices (ACIP) recommended the nasal spray for kids ages 2 to 8 — provided the children had no medical reason for not taking it (see below). But just a year later, ACIP reversed its decision, after researchers found the nasal spray hadn’t protected kids against the influenza A (H1N1) strain during the 2013-2014 flu season.

What should you do? In its latest recommendations, ACIP says there isn’t enough evidence to pick one vaccine over another. The choice is up to you and your child. Kids who are needle-averse can get the spray instead — with a few exceptions.

Special cases

Children with certain medical conditions should not get the nasal spray vaccine because it hasn’t been proven safe for them. These include kids with asthma, immune-suppressing conditions, seizures, metabolic disease, diabetes, lung disease, and kidney disorders. Children who received any live virus vaccine in the previous four weeks and those who are taking antiviral flu medicine should also avoid the nasal spray. And if your child has a stuffed nose, wait until it clears up because the congestion can block vaccine delivery.

Any child with an egg allergy will likely have to avoid both types of flu vaccines, which are produced in eggs and contain a small amount of egg protein. If your child is running a fever on the day of the vaccination, check with your doctor. You may need to put off the shot or spray.

Don’t wait

Provided one — or both — of the vaccines is safe for your child, get immunization out of the way as early in the season as possible — ideally by October. Children ages 6 months to 8 years will need to receive two doses if they haven’t done so before, and the doses need to be given at least four weeks apart.

“Now is the time to call your pediatrician and make an appointment, or find out when flu clinics start,” said pediatrician Wendy Sue Swanson, MD, MBE, FAAP, a spokesperson for the AAP. “Flu vaccine is a critically important, every-year vaccine that can protect your child from very serious illness and death due to a virus that is so often common in our communities, and so common in childhood.”