Parents often assume injections are the only flu protection for children, but NHS recommends nasal sprays that target the infection site, with certain age and health exclusions. Experts highlight differences in immune responses and recent updates on allergy guidelines.
Parents are often surprised to learn that many children are offered a nasal flu vaccine rather than a jab, but the choice is driven by how the protection works rather than by avoiding pain. NHS GP Shruti Nathwani, who has paediatric training, said the spray is designed to act where flu usually enters the body: the lining of the nose. That creates a local immune response as well as broader protection through antibodies and T cells, whereas an injection mainly prompts antibodies in the bloodstream.
The nasal option is the live attenuated influenza vaccine, which uses weakened virus to train the immune system without causing flu. The US Centres for Disease Control and Prevention says the spray is approved for healthy people aged two to 49, while the injectable flu vaccine is an inactivated vaccine that is often used when the spray is not suitable. In practical terms, both aim to reduce the risk of flu, but they do so in different ways and for different groups.
NHS guidance, as explained by Nathwani, says some younger children are given an injection instead of the spray. That includes babies aged six to 23 months, after studies found an unexpected rise in wheezing and hospital admissions in that age group. Other children who should not receive the spray include those under two, children with a severe weakened immune system, and some who live with someone who is profoundly immunocompromised.
Nathwani also said asthma does not automatically rule out the nasal vaccine, but current wheezing, recent reliance on a reliever inhaler or severe asthma can make it unsuitable. The Mayo Clinic and Children’s Health note that children aged two to eight who have not previously had the nasal vaccine may need two doses, at least a month apart, depending on their vaccination history and age.
Parents are also being told that an egg allergy is no longer considered a reason to avoid the spray under updated UK guidance, although vaccination teams should still be told about any allergies in advance. Side effects are usually mild and can include a reduced appetite, runny nose, headache or tiredness. Nathwani said transmission of the weakened virus to others is very unlikely, but parents should tell staff if a child has close contact with someone who is severely immunocompromised.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
