By: Kristina A. Bryant, MD, FAAP
Influenza (the flu) can be deadly for older adults. But did you know that the flu can be very serious for babies and young children?
Last flu season was off to an early start. In October 2022, flu hospitalization rates were the highest in 10 years for children under age 4 years and older adults.
The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) encourages as many children as possible to get a
flu vaccine every year. Babies and children can get other recommended immunizations when they get their flu shot.
Fortunately, parents and caregivers have immune-boosting tools to keep babies healthy. Influenza may be spreading in many areas, but it is not too late to get a flu shot. We do not know how long or severe this influenza season will be. Read on for ways to prevent flu from spreading to infants and young children.
Are babies and young children at higher risk from the flu?
Yes. Because of their age, even healthy babies and young children are at higher risk of getting very sick from the flu. Here's what we know:
Kids younger than age 2 years are at highest risk.
Infants younger than age 6 months have the highest rates of hospitalization and death. They are too young to be vaccinated.
Healthy children age 2 years to 5 years are more likely to be taken to a doctor, an urgent care center or the emergency room because of flu, compared to older healthy kids.
Parents also should keep in mind:
Your baby's immune system is still developing. This can put them at higher risk of infection from viruses like flu or make it harder to respond to infections.
Your young child may not have been exposed to influenza viruses. Because the past two flu seasons were mild, some young children might not have immunity to influenza.
Does my baby need two doses of the flu shot?
Maybe. Two doses are needed if your child is age 6 months to 8 years and:
it is the first time they are being vaccinated against influenza or
they have only received one dose of flu vaccine ever before July 1, 2023.
The doses are given four weeks apart. After the first dose, the immune system gets ready to respond to influenza. Young children may not have a high level of immune protection yet. After the second dose, they have a higher level of immune protection. Just one dose is needed each year after that.
Two weeks after they receive all recommended doses of flu vaccine, their immune system will be fully ready to respond. The next time your child is exposed to influenza, they will be better prepared to avoid getting very sick. Babies can get the flu shot at any point in the flu season. Sooner is better, especially the first time they get the vaccine or if they only had one dose ever.
Do breastfed babies need a flu shot?
Yes. Flu vaccines are recommended for pregnant and breastfeeding people and their babies age 6 months and older.
Getting a flu shot while pregnant or breastfeeding helps your baby boost their immune system. Antibodies against flu are passed to your baby in the womb or through breastmilk.
Once babies are 6 months or older, being vaccinated enhances their immunity.
Household members benefit from immune-boosting protection of the influenza vaccine, too. They will be less likely to expose babies to the flu. It's like having a cocoon around the baby to protect them if they are too young to be vaccinated.
When should I call the pediatrician about my baby's flu symptoms?
If your baby or young child has emergency warning signs of flu, seek medical care for them right away.
Young children or those with underlying medical conditions are at a higher risk of complications from the flu. Your pediatrician can help determine if they need flu antiviral drugs. Flu antiviral drugs work best when they are started within 48 hours of the start of symptoms. However, they can be started later in children who are severely ill or at high risk. Parents and their pediatrician should discuss the risks and benefits of antiviral medication.
Any child who has worsening flu symptoms should be examined by a health care provider. Keep in mind that:
Children who develop breathing difficulties may need to be treated with oxygen or require other respiratory support.
Vomiting and diarrhea can cause dehydration. When this happens, they may need extra fluids given through an intravenous catheter.
Antibiotics do not treat the flu. However, your child may need them if they develop an ear infection, bacterial pneumonia or other problem.
Antiviral drugs prescribed to treat COVID-19 do not work to treat flu. Only flu antiviral drugs work to treat flu.
What should parents of young children do if they get sick with influenza?
Parents or caregivers who develop flu symptoms should call their health care provider to determine whether they need antiviral medicine.
Ideally, sick caregivers should arrange for another healthy adult in the home to care for their baby or young child. If no other caregiver is available, wear a face mask when holding, feeding or providing care to help prevent the spread of virus.
Remember
The flu virus is common. It is also not predictable. Most people who get the flu are sick for at least a week. Some people get much sicker, and even healthy young children may get very sick.
For children who are at least 6 months of age, influenza vaccine is the best way to avoid serious illness. And to protect children younger than 6 months, influenza vaccination is recommended for all eligible family members every year.
More information
About Dr. Bryant Kristina A. Bryant, MD, FAAP, a pediatric infectious diseases specialist at the University of Louisville and Norton Children's Hospital, is a member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, lead author of the annual AAP influenza policy statement and technical report, and lead for the AAP Red Book Online. She also is the immediate-past president of the Pediatric Infectious Diseases Society.
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