Flu shots have arrived to nearly every neighborhood in the US. Frustratingly, clinics often get the doses after the retail stores (seems silly) and doses for children under age 3 may not arrive at the same time. So if you’re reading all over the planet that shots are available and your pediatrician’s office can’t offer it to you today, have patience. Children under age 3 receive immunization doses without preservative, so if a store or pharmacy advertises that they have “flu shots” it doesn’t mean they offer them to all comers. Pediatric doses are not offered at many retail locations. Often, like so many things in medicine, the same rules don’t always apply to infants and children. But that being said, clinics expect to get all the doses needed for our high-risk (and low-risk) patients in time this year (no expected shortage) and can help you determine when, how, and why to get a flu shot for your child. This year, it is more confusing than ever.

Getting your flu shot early in the season will always benefit you and your family. The earlier you get your shot, the earlier you’re all protected.

Since 2008, the AAP has recommend nearly all children over 6 months get flu shots each season. This year, however, you may need a bit more help figuring out how many dose your child will need. H1N1 (Swine flu) muddied the waters. What you did (or didn’t do) for your child last year, and in years prior, affects how many doses of the flu shot your infant or child needs this year.

Using a few rules, you can determine how best to protect your child against seasonal influenza and influenza caused by H1N1.

The 2010 flu shot (or Flumist for children over 2 years of age without asthma or other medical problem that places them at high risk) covers both H1N1 and seasonal flu. Recommendations, seen here in a flow chart to simplify decision-making, are dependent on age, previous history with H1N1 shot/illness, and previous seasonal flu shot history. It may feel like there is advanced math involved…

The Rules for 2010 Influenza Immunization:

  • Children younger than 6 months are too young to receive influenza vaccine.
  • All children 9 years of age and older only need 1 dose.
  • Children younger than 9 years need a minimum of 2 doses (total) of 2009 pandemic H1N1 vaccine. If they did not receive the H1N1 vaccine during last year’s flu season, they will need two doses of the flu shot/mist this year. For protection against H1N1, this year’s flu shot can be considered a “booster” to last year’s H1N1 shot.
  • Children younger than 9 years who have never received the seasonal flu vaccine before will need 2 doses.
  • Children younger than 9 years who received seasonal flu vaccine before the 2009-2010 flu season need only one dose this year if they received at least 1 dose of the H1N1 vaccine last year. They need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.
  • Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received 1 dose, should receive 2 doses this year.
  • Children younger than 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive 2 doses this year.
  • All children who need 2 doses should receive the second dose at least 4 weeks after the first dose.

Clear as mud? If you’re confused, particularly for your under-9-year-old, the clinic that administers the doses will help you sort out the above rules. For more on cracking the code, watch the video, too.