6 Things You Need to Know about Kids and the Flu Shot

November 25, 2019

During last year’s flu season, more than 60% of children were vaccinated. That may sound high, but experts say everyone 6 months old and older without contraindications should get a yearly flu shot.

Why are influenza vaccination rates in children still below recommended levels? One reason, says Melissa Stockwell, MD, MPH, a pediatrician and vaccine behavior researcher at Columbia University Vagelos College of Physicians and Surgeons, is logistics. “Bringing a child into the doctor’s office just to get a flu shot is a barrier for many patients,” she says. “Even people who intend to get their child vaccinated may put it off, thinking they will do it another day.

“Layered on top are misperceptions about influenza and the vaccine, which contribute to the lower vaccination rates we’ve seen for flu versus other childhood diseases, combined with general fears about vaccine safety."

Here’s what Stockwell tells families—and other physicians—to encourage more families to get their children vaccinated against the flu.

The flu is far more serious than a bad cold.

There's definitely a misperception that the flu is just a bad cold. That is partly because we use the word ‘flu’ for milder illnesses that aren’t caused by the influenza virus, like ‘stomach flu.’ Many people don't really understand what the flu is and how serious it can be. If you don't feel that the disease is serious, then it's harder to be convinced to get a flu shot.

But if you talk to anyone who's had the flu, it's really unlike any cold most people have had. People with influenza often say they felt fine one moment and then a few minutes later they felt like they were hit by a truck. Not everyone has that classic symptom, but when they do, we clinicians start thinking that it’s the flu. Compared to other viruses, the flu causes a higher fever that lasts longer, about seven to 10 days, and makes people feel terrible, very tired, and achy. People can also feel tired for a long time after the flu. As with other virus illnesses, many people who get the flu also get a sore throat and/or cough. They can also get a runny or stuffy nose and headaches.  

The elderly are at greater risk of complications from the flu, but a lot of people don’t realize that the flu can be dangerous and even deadly for young, healthy people, too. Last year alone, the flu killed 180 children in the U.S.

The flu vaccine provides children with the best protection against these risks, and because school-aged children are thought to be the biggest spreaders of flu virus, vaccinated children also protect others in the household.

You need to get a flu shot every year.

The flu shot is different from other types of vaccines, because the protection only lasts for a year. That’s because the strains of influenza virus that are circulating vary year to year. Unfortunately, we don't have one universal flu vaccine that can protect us from all strains, although researchers are working on it. 

The need for a yearly shot does reduce vaccination rates. With other childhood vaccines, we can give kids a series of primary vaccinations followed by a booster shot every so often, and then they’re protected for 10 years or longer.

Flu vaccine doesn’t cause the flu.

A lot of people have the misperception that the flu shot causes the flu. We know that isn’t possible because of the way that the flu shot is made.

In the fall and early winter when most people get a flu shot, there may be several other cold viruses circulating that cause respiratory illnesses. When someone gets a flu shot and then gets a cold, they may mistakenly attribute their illness to the vaccine and think that they have the flu.

But although some symptoms of cold and flu may overlap, a cold is not the flu.

Flu vaccine saves lives.

We know that the flu shot may not work as well as other childhood vaccines, but it still offers an important level of protection.

One study, published in 2017, showed that flu vaccination decreased the risk of dying from the flu by almost two-thirds in healthy children and by half for children with underlying high-risk medical conditions.

If your arm hurts, it means the vaccine is working.

As with any vaccine, some people can get some redness or swelling at the injection site. It can be a good sign that your body is reacting to the vaccine the way we want it to, by making antibodies to the virus. The reaction usually only lasts for a day or two, and it can be treated with an analgesic or a cold compress. 

If your arm doesn’t hurt, don’t worry—the flu shot may be working even if there’s no pain or swelling.

Doctors need to tailor messages about the flu shot to parents’ concerns. 

One of the goals of my research is to find ways to increase vaccination rates in children.

In one study, we found that giving parents old-school printed handouts about the flu while they’re in the waiting room increases vaccination rates by the end of the season. 

We’ve also found that sending reminders via text messaging increases vaccination rates, especially when the messages include educational information about why flu vaccination is important. 

But we have to be careful about the content in our messaging and handouts. There was a really interesting study that found that offering “corrective information,” like the fact that people cannot get the flu from flu vaccine, to families that were already vaccine-hesitant made them even less likely to intend to get a flu shot.

So it’s complicated, and every family has different concerns that influence their decision-making. In my practice, I try to tailor my messages to my patients’ concerns.  

Melissa Stockwell, MD, MPH (CUIMC)

For families that are hesitant, I ask them what they’ve heard about the flu. If they believe the flu isn't serious, I give them key information about how the flu actually can be deadly, and I may share a personal story about people I know who have died from the flu.

An equally important point for doctors is not to miss the opportunity to vaccinate. We do know that doctor recommendations are very important, so we should keep offering the flu vaccine and use every child’s visit to the pediatrician’s office as an opportunity to vaccinate.

The good news is that while we had seen a drop in influenza vaccine coverage among children, the most recent data suggests that this trend may be reversing. In addition, scientists at the NIH just began a trial to study the effectiveness of a universal influenza vaccine. If it’s effective, it could mean that our days of needing a flu shot every year may eventually be behind us.


More Information

Melissa Stockwell, MD, MPH, is associate professor of pediatrics and associate vice chair, clinical and health services research, at Columbia University Vagelos College of Physicians and Surgeons and associate professor of population health at Columbia University Mailman School of Public Health.