The American Academy of Pediatrics is recommending annual influenza vaccination for every child aged 6 months and older without a medical contraindication, guidance released as families begin back-to-school appointments and after a season in which 190 U.S. children died of flu.
The recommendation itself is not new. What gives it weight this year is the gap between the advice and the behavior. Fewer than half of American children were vaccinated against influenza last season, a rate close to the year before, and historically about 85 percent of children who die of flu have not been vaccinated.
For parents, the decision point is arriving now rather than in October. Children who need two doses require four weeks between them, so a first appointment in August or early September is necessary to achieve full protection before flu begins circulating.
A Severe Season Sits Behind the Recommendation
The AAP policy statement and an accompanying technical report, both published online in Pediatrics and scheduled for the September issue, follow what the organization characterized as another high-severity season for children.
The AAP notes that the 190 pediatric death toll continues to rise because of delayed reports, which is why the figure exceeds the count federal surveillance carried earlier in the summer. Pediatric flu deaths reach the federal system on a lag, and season totals typically climb for months after activity subsides.
Children also experience influenza differently from adults. Beyond fever and respiratory symptoms, pediatric flu can present as bronchiolitis, croup, vomiting, diarrhea, or abdominal pain, which is one reason cases are sometimes mistaken for a stomach virus in young children.
Coverage Has Stalled Below Half of U.S. Children
Through mid-May of this year, 49.4 percent of children aged 6 months through 17 years had received a flu vaccine, according to the American Academy of Pediatrics. That is close to the prior season's figure and well below the level pediatricians consider adequate.
"The good news is flu vaccines have been thoroughly studied," said Kristina A. Bryant, a member of the AAP Committee on Infectious Diseases, which wrote the policy statement and technical report. She added that the vaccines are known to be safe in children and prevent not only hospitalizations and deaths but also a substantial number of illnesses that lead to doctor visits each year.
The coverage gap exists amid a broader period of confusion about childhood immunization guidance. Federal officials moved six vaccines, including influenza, off the universally recommended childhood schedule in January, a change a federal court stayed in March, and the CDC had not released its own influenza recommendations for the coming season as of the AAP release. Many pediatric practices are following AAP guidance in the interim.
The Protection Flu Vaccination Is Documented to Provide
The AAP is precise about what the vaccine does, and readers should be too. It is not a guarantee against infection. The organization cites research by CDC scientists, published in Pediatrics, finding that vaccination reduces the risk of flu-related death among children and teenagers by 80 percent. In a separate analysis, the CDC estimated that flu vaccines prevented nearly 15,000 hospitalizations and 245 deaths in children and teenagers during the 2024-2025 season.
These are the AAP's characterizations of the available evidence rather than independent findings, and effectiveness varies year to year depending on how closely circulating strains match the vaccine formulation.
The AAP does not express a preference among licensed products. Any licensed influenza vaccine appropriate for a child's age and health status can be administered as soon as possible in the season, without preference for one product or formulation.
Timing, Doses, and Where Families Can Get Shots
The dosing rules are unchanged. Children aged 6 months through 8 years who are receiving the influenza vaccine for the first time, who have received only one dose ever before July 1 of this year, or whose history is unknown should get two doses at least four weeks apart. Everyone else needs one. Ideally, all doses should be completed by the end of October.
The influenza vaccine can be given at the same visit as other vaccines, which is helpful for families consolidating back-to-school appointments. The AAP also recommends vaccination during pregnancy, which protects both the pregnant person and an infant too young to be vaccinated, and says vaccination while breastfeeding is safe.
Cost is generally not a barrier, though families should confirm coverage before an appointment rather than after. Most private insurance plans, Medicaid, and CHIP cover the influenza vaccine without cost-sharing, and pharmacies often administer it for older children at no charge. Uninsured and underinsured children are eligible through the federal Vaccines for Children program, available at participating pediatric offices, community health centers, and many local health departments.
Timing also intersects with school calendars. Practices that consolidate flu vaccination into a single well-child visit can miss children who need a second dose, since the four-week interval means a September first dose leaves an October follow-up that families sometimes skip. Parents whose child needs two doses should book both appointments at the same time.
Antiviral treatment is a separate question from vaccination. The AAP recommends antivirals for children hospitalized with influenza or with severe or progressive illness, and for children in outpatient settings who are at high risk of complications, including those with chronic medical conditions and immunocompromised children.
Supply questions are worth asking early as well. Vaccine formulations and presentations vary year to year, and some products intended for the youngest children have had limited availability in past seasons. A pediatric office can confirm what it has in stock and whether an appropriate formulation is available for a child under three.
What remains unsettled is whether federal recommendations for the coming season will align with those of the AAP. Pediatricians interviewed after the recent executive order on childhood immunization have emphasized that the shots themselves remain available and that families uncertain about which schedule their pediatrician follows can simply ask when booking. Any decision to delay or skip a dose for a child with a medical condition belongs to that child's clinician.
Key Questions Answered
Who should get a flu vaccine this season? The AAP recommends annual vaccination for every child aged 6 months and older who does not have a medical contraindication, and also recommends vaccination during pregnancy.
How many doses does my child need? Children aged 6 months through 8 years getting the flu vaccine for the first time, or with only one prior lifetime dose before July 1, need two doses four weeks apart. Others need one.
When should we schedule it? As soon as the vaccine is available, with all doses ideally completed by the end of October. Children needing two doses should start earlier.
Does the vaccine prevent all flu? No. The AAP cites CDC research showing an 80 percent reduction in flu-related deaths among children and teens, and says the vaccine prevents hospitalizations and many illnesses, but infection is still possible.
Is there a preferred brand? No. The AAP says any licensed vaccine appropriate for a child's age and health status can be used, without preference.
What if we cannot afford it? Most insurance, Medicaid, and CHIP cover it at no cost. Uninsured and underinsured children qualify for the federal Vaccines for Children program.
Has the CDC issued its own recommendation? Not as of the AAP release. Federal childhood vaccine guidance has been subject to a court stay, and many pediatric practices are following AAP guidance.
