Should My Child Get the Flu Vaccine? An Integrative Pediatrician’s Guide to 2025-26 Effectiveness, Risks & Immune Resilience

Should my child get the flu vaccine? That is the question…

Or at least, it’s a very common question I get as an integrative pediatrician this time of year.

So I wanted to share an update with all of you on the latest information we have on how effective the 2025-26 influenza vaccine is likely to be, and what that means for your family.

PLEASE NOTE: This article is for parents who want to look beyond a simple ‘yes or no’ recommendation and understand the nuances of influenza vaccines, circulating strains, immune function, and how to support their child’s resilience regardless of their vaccination choice.

I believe that the decision to get the flu vaccine for your child, just like any other vaccine, is YOUR CHOICE as a parent, and it’s a very personal choice with many factors that have to be weighed. This decision must be made on an individual basis, taking into account the unique healthcare needs and concerns of your child and family.

What exactly is the “flu”?

Before we dive into the flu vaccine, let’s take a look at the flu itself.

Influenza, or the “flu”, is caused by any of a number of influenza viruses. There are several other non-influenza viruses that circulate during the winter and cause upper respiratory infections and influenza-like illnesses, including RSV, COVID-19, adenovirus, rhinovirus, and metapneumovirus, to name a few. For the purposes of this article, the “flu” refers to those illnesses actually caused by the influenza virus, and the “flu vaccine” refers specifically to the influenza virus vaccine.

Symptoms of the flu can range anywhere from mild cold-like symptoms to high fevers, chills, fatigue, sore throat, runny nose and cough, headache, body aches, and vomiting/diarrhea. Up to one-half of those infected with the influenza virus will not develop flu symptoms, and more than two-thirds will have a relatively mild illness that does not meet the criteria for a severe acute respiratory infection (SARI) or influenza-like illness (ILI). (1,2,3)

While there are certainly people who get very sick and have complications from influenza infection, the vast majority will not have an illness severe enough to even consider hospitalization. Most people who get the flu will recover within days to 2 weeks without any complications.

Patients who are more likely to have serious complications from the flu are (4):

Adults 65 years and older
Children younger than 2 years of age (especially infants younger than 6 months)
People with certain chronic medical conditions, including asthma and chronic lung, heart, kidney, or liver disease; neurologic and neurodevelopmental conditions; blood disorders (such as sickle cell disease); endocrine disorders (such as diabetes and extreme obesity), inherited metabolic and mitochondrial disorders, and immunosuppression due to disease or medication.
Pregnant persons up to 2 weeks post-partum
Residents of long-term care facilities

How “bad” will this year’s flu season be?

As we enter flu season, it would be great to know 2 things: how “bad” this year’s flu season will be, and how effective this year’s flu vaccine will be.

Aah – the million-dollar questions.

The CDC’s 2025-26 Respiratory Disease Season Outlook (5) analyzes trends in COVID-19, RSV, and influenza-associated hospitalization rates to try to predict this year’s trend. Using this modeling, the CDC anticipates that this year’s influenza severity, based on influenza-associated hospitalization, will be “moderate” across all ages, compared to a high-severity season across all ages last year during the 2024-25 influenza season. So that’s some good news …

We can try to predict what our 2025-26 winter respiratory season will be like by looking at how the Southern Hemisphere experienced its 2025 winter respiratory season (which occurred during our summer). Influenza activity was classified as “low-moderate” in several Southern Hemisphere regions, although some countries experienced intense respiratory seasons driven by other non-influenza viruses, including what is now called a “tripledemic” of influenza, COVID-19, and RSV.

And beyond a tripledemic, many more respiratory viruses circulate than just influenza, COVID-19, and RSV during the winter. In the Southern Hemisphere, rhinovirus and enterovirus were the leading causes of ICU admissions for respiratory infections, followed by influenza. In children, metapneumovirus, rhinovirus, and Bordetella pertussis accounted for more pediatric ICU admissions than influenza. (6)

This highlights the need for a broad, integrative approach to supporting your family’s immune system during the winter respiratory season – whether or not you get the flu vaccine (more to come below).

How effective is the flu vaccine in general?

According to the CDC’s annual vaccine effectiveness studies (7) conducted since the 2004-2005 flu season, the flu vaccine’s overall effectiveness has ranged from 10% in 2004-2005 to 60% in 2010-2011. This number varies quite a bit for different populations. The flu vaccine will only be effective if those who receive it mount an appropriate immune response. While 97% of adults ages 18-64 who received the vaccine may show protective antibody titers at 21 days after vaccination, the same isn’t necessarily true for children. At 10 days, the antibody response to the flu vaccine in kids under 9 years old is much lower. The low response in children under 9 years of age accounts for the recommendation that children 6 months-9 years who are receiving their first flu vaccine receive 2 doses approximately 1 month apart.

When we look at the effectiveness data that’s actually available, the numbers don’t look encouraging. The Cochrane Library provides a database of systematic reviews of the scientific literature on specific questions, such as “Is the flu vaccine effective in preventing influenza in healthy adults?” A 2010 Cochrane review (8) of 50 studies looking at this very question found that “in the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation [emphasis added], 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms.” The authors conclude that “influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission” [emphasis added].

More recent studies do show a modest but positive effect of influenza vaccines. A 2021 review (9) of studies found that vaccination did not significantly reduce the risk of hospitalization in adults with influenza. But in adults already hospitalized with influenza, the influenza vaccine was associated with a 26% reduced risk of ICU admission and 31% reduced risk of death. There was also a 45% reduced risk of developing a fever if a vaccinated child actually contracted influenza. But remember, fever is not necessarily something to be feared. To understand the ins and outs of fever and why you should not have fever phobia, please read my free Guide, The Top Mistakes Parents Make When Their Kids Have a Fever, and What to Do Instead.

The flu vaccine is also not without potential risk. In the Cochrane review above, the flu vaccine was noted to cause “an estimated 1.6 additional cases of Guillain-Barré Syndrome per million vaccinations,” although “the harms evidence base is limited” and the authors make the WARNING that “industry [READ: vaccine manufacturers] funded studies were published in more prestigious journals and cited more than other studies… The review showed that reliable evidence on influenza vaccine is thin, but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.”

There is an immune-mediated phenomenon called vaccine-associated enhanced disease (VAED), where vaccination can paradoxically increase disease severity upon subsequent natural infection. This has been described after the RSV and measles vaccines. (10) While VAED has not been described with the influenza vaccine, some observational data suggest the immune modulation from vaccination may have unintended consequences.

One Canadian study (11) found that patients who had received the flu vaccine in the 2008-2009 flu season had a 1.4-2.5 times higher risk of needing medical care for illness from the pandemic H1N1 flu during the following 2009-2010 flu season. The editor cautions that this observational study doesn’t prove that there is a direct link between getting the flu vaccine and having a higher risk of contracting the flu the following year and is therefore not conclusive, but does note that “if the findings in the current study are real, however, they raise important questions about… the best way to prevent and control both types of influenza [seasonal and pandemic] in future.”

A non-peer-reviewed study looking at the effectiveness of the influenza vaccine during last year’s 2024-25 respiratory viral season found that among 53,402 Cleveland Clinic employees, those who were vaccinated had a 27% increased risk of contracting influenza than those who were unvaccinated. (12) Note that this paper did not assess differences in severity of illness/hospitalization between vaccinated and unvaccinated employees.

Two other studies are notable to me as an integrative pediatrician who wants to dive into the good, the bad, and the ugly of all “sides” to formulate as unbiased a decision as possible. One study (13) in children found that those who received the influenza vaccine had up to 4.4X (and up to 14.8X) increased risk of contracting a non-influenza viral infection in the following 9 months. The authors speculate that immunity to the flu after influenza vaccination may cause virus “interference” with loss of short-term nonspecific immunity to other respiratory viruses. Another study (14) looked at college students with symptomatic influenza infection, and found that those who had received the influenza vaccine in the current and prior season had 6.3X higher fine-aerosol viral shedding.

So where does that leave us? From what I can tell, if you choose to get the flu vaccine, AND it’s a good match for circulating influenza virus strains, then you may have a slightly lower chance of developing flu symptoms but not its complications, although if you are hospitalized, you may have a lower risk of being admitted to the ICU or dying. But there is also a very small chance of developing an autoimmune complication (Guillain-Barré), and perhaps a small chance of having a higher risk of contracting influenza or a different respiratory infection, and also a small chance of being more contagious. Hmmm…

It seems the most important question to answer next is: How effective is this year’s flu vaccine?

Is this year’s flu vaccine a good match to circulating strains?

When looking specifically at this year’s vaccine, we need to determine whether it is a “good match.” A “good match“ means that the flu strains that are in the flu vaccine are similar to the strains that are circulating in the community. As you may be aware, the flu vaccine is made by predicting the 3 most prevalent flu strains that will circulate the following year. Some years, none of the flu strains in the vaccine match the circulating flu strains. Other years, they have a better match.

I have been closely monitoring the CDC’s Weekly U.S. Influenza Surveillance Report (15), which provides weekly updates on national flu activity (which lags by 1-2 weeks), to see whether the flu vaccine is a good match this year. Fortunately, as of the week ending November 15, 2025, influenza activity remained low throughout the United States, but that means it’s too early to tell which influenza strains will predominate this winter. At the moment, it appears that Influenza A strains predominate over Influenza B strains, and that of the Influenza A strains, A(H3N2) is more common than A(H1N1)pdm09.

Until we get more data, we can again look to the Southern Hemisphere’s 2025 winter. Their flu vaccine used the same strains as our current flu vaccine, and it is anticipated that we will see similar circulating influenza strains. The caveat here is that in most of the Southern Hemisphere, Influenza A(H1N1)pdm09 was the predominant circulating strain, with some A(H3N2) and some B/Victoria. Currently, it appears that A(H3N2) is the most prevalent strain in the Northern Hemisphere – we will need to watch this closely as studies consistently show that influenza vaccine effectiveness is LOWER for Influenza A(H3N2) compared with A(H1N1)pdm09 and B. (16, 17)

Here’s the good news: In Australia, 98-99% of circulating (H1N1)pdm09, H3N2, and B/Victoria were a good match to their respective strains in this year’s influenza vaccine.

When looking at Southern Hemisphere data, we can see the following vaccine-circulating strain matches:

A(H1N1)pdm09 — Strong match
A(H3N2) — Good match
B/Victoria — Strong match

Is this year’s flu vaccine effective even with matching strains?

Being a good match doesn’t necessarily mean that the vaccine will be effective in reducing influenza severity in real life.

Vaccine effectiveness studies look at effectiveness against:

Outpatient influenza-associated illness, and
Influenza-associated hospitalization

Here’s what real-life data showed us from the Southern Hemisphere (18):

Vaccine effectiveness against outpatient influenza-associated illness (ILI): 50.4%.
Vaccine effectiveness against influenza-associated hospitalization (SARI): 49.7%.

But what does that actually mean?

Vaccine Effectiveness Against Outpatient Influenza-Associated Illness

Vaccine effectiveness against outpatient influenza-associated illness (ILI) looks at how much the flu shot protects you against symptomatic, lab-confirmed influenza that’s severe enough for you to seek outpatient care (clinic, urgent care, or ER without admission). If you test positive for influenza A or B, that visit is counted as an “influenza-associated outpatient illness.” Those diagnosed with “influenza-associated outpatient illness” are then compared by vaccination status.

It does not measure:

All influenza infections. Remember, up to half of people with the flu are asymptomatic, and many mild/asymptomatic cases never get tested.
Transmission (whether you pass it to others).
Disease severity beyond the outpatient visit (hospitalization/ICU/death are separate endpoints).
Illness from other viruses (those are the “test-negative” controls).

So, across all ages, your chance of developing symptomatic influenza symptoms that caused you to go to urgent care to get tested was cut in half if you were vaccinated, compared to if you were not vaccinated. There is no pediatric-specific or strain-specific data for outpatient influenza-associated illness.

Vaccine Effectiveness Against Influenza-Associated Hospitalization

Vaccine effectiveness against influenza-associated hospitalization measures how much vaccination reduces the risk of hospitalization with lab-confirmed influenza among vaccinated versus unvaccinated individuals.

It does not measure:

Vaccine effectiveness against hospitalization from other viruses.
Risk of ICU admission, ventilation, or death (those are separate endpoints).
Whether the vaccine reduces infection severity

In the Southern Hemisphere, vaccine effectiveness against hospitalization due to specific influenza virus types was:

A(H1N1)pdm09: 41.6%
A(H3N2): 37.2%
B/Victoria: 77.6%

(Note that effectiveness against hospitalization with A(H3N2) was less than for other influenza strains. We will have to wait and see whether A(H3N2) continues to be the most predominant strain in the US as this winter progresses.)

Vaccine effectiveness for hospitalizations (SARI) due to any influenza virus by age was:

Young children: 51.3%
People with comorbidities: 51.9%
Older adults: 37.7%

If we break down pediatric data according to influenza virus strain, vaccine effectiveness against hospitalization (SARI) was noted to be:

Any influenza (young children): 51.3%
A(H1N1)pdm09 (young children): 53.4%
A(H3N2) (young children): 30.3%
B/Victoria (young children): 64.4% VE

So, should your child get the flu vaccine?

With all of these statistics, you may still be wondering, “Should my child get the flu vaccine?” This is a tough question to answer, and a decision that only you can make for your child. For some parents, 30-50% effectiveness sounds great, and for others, it feels more like the toss of a coin.

The decision to get the vaccine depends on what risks you, as patients and parents, are willing to take. While influenza infection tends to produce mild illness in most, it certainly can cause more serious and even life-threatening complications, especially for those populations considered at risk. I have cared for children hospitalized in the Pediatric Intensive Care Unit from influenza complications. On the other hand, no vaccine is 100% risk-free. The most well-established serious risk is Guillain-Barré syndrome, which occurs in approximately 1-2 cases per million doses. In my decades of integrative pediatric practice, I have also seen rare cases where serious health conditions developed after vaccination, including Guillain-Barré and multiple sclerosis. It is important to note that temporal association does not prove causation, but when something significant happens after vaccination in one of my patients, it makes me take pause, and reinforces my commitment to individualized risk-benefit assessment for each family.

I typically recommend that patients with lung/heart disease or other serious chronic illness receive the vaccination, as they are at higher risk for serious flu complications. Apart from that, the decision really needs to be made on an individual basis, considering your child’s unique health history and your family’s values.

The flu vaccine is contraindicated for patients who have had a severe allergic reaction to a previous flu vaccine or vaccine component. As an integrative pediatrician, I exercise additional caution in patients who have experienced Guillain-Barré syndrome after previous vaccination or have a family member who has, and in patients who have a strong personal or family history of autoimmune or neurodegenerative illnesses. While this goes beyond standard CDC recommendations, functional medicine looks at individual susceptibility factors that conventional guidelines do not always address.

The field of adversomics tries to assess the personalized genomic factors that may increase the risk for serious adverse vaccine reactions. From an integrative pediatric standpoint, one of the factors that may increase individual susceptibility for vaccine reactions includes underlying “mitochondrial dysfunction,” which may be present in children with a personal history of delayed developmental milestones or family history of autoimmune illness, neurodevelopmental or neuropsychiatric concerns like autism or PANS/PANDAS, cancers, or other chronic illness. For these patients, vaccination is not necessarily out of the question. In my practice, I work with patients to optimize physiologic resilience before and after vaccination by supporting mitochondrial function, methylation pathways, and detoxification systems with diet, lifestyle and nutritional supplements like coQ10, methyl-B12, and glutathione, and specialized pro-resolving mediators.

(For families and practitioners interested in my specific protocols, I have compiled the supplements and dosages I use in my V-Support Kit and V-Support Kit for Kids.)

I also don’t recommend getting shots when kids have even a hint of a cold or illness coming on – if we’re asking our child’s immune system to mount an appropriate and effective response to the flu vaccine, or any other vaccine for that matter, why give a vaccine when their immune systems are occupied with something else?

Putting It All Together

Here’s what we know:

For most people, the flu will be relatively mild and without complications.
The 2025-26 flu vaccine does appear to be a good match for circulating influenza strains.
The flu vaccine may reduce symptomatic flu requiring a doctor’s visit and hospitalization by around 30-50% for children, with the least effectiveness in children against the A(H3N2) strain.
Certain populations are more at risk for serious complications from the flu.
Certain populations are more at risk for serious complications from the flu vaccine.
Serious adverse vaccine reactions may be mitigated by supporting mitochondria, methylation, and detoxification.

Here’s what we don’t know:

How effective the flu vaccine is in reducing your risk of actually contracting the flu
How effective the flu vaccine is in reducing how much you transmit (spread) the flu if you actually contract it.

What to watch for: If Influenza A(H3N2) continues to be the predominant circulating strain in the US, protection against hospitalization for children and adults may be much lower.

Bottom line

Whether you decide to get the flu vaccine for your child is YOUR CHOICE – and the risks of your child getting complications from the flu must be weighed against the risk of your child getting complications from the flu vaccine. Only YOU can decide what risks you are willing to take.
If you decide to give your child the flu vaccine, please make sure that they are in their best health.
If your child has any risk factors for serious adverse reactions to the flu vaccine, then consider supplementing with coQ10, methyl-B12, glutathione, and specialized pro-resolving mediators.

There is NO right or wrong decision. By informing yourself, you are doing the best thing for your child and for your whole family. Trust your mama or your papa “gut”, and you will always do what is best for your child.

And, whether or not you get the flu vaccine, it is still essential to support immune resilience against all of the respiratory viruses that may come your family’s way this winter.

Immune Resilience is the Key – vaccine or not

Building immune resilience is essential to support your family throughout the winter respiratory season and beyond. Whether you choose to vaccinate or not, remember that the flu vaccine only addresses influenza virus – it doesn’t protect against RSV, COVID-19, rhinovirus, metapneumovirus, adenovirus, or the many other respiratory viruses circulating this winter.

Instead of heading into the flu season with fear, arm yourself with the knowledge of how to use pediatrician-approved natural remedies to boost your child’s immune system, and recover quickly and completely when the inevitable winter virus comes your way.

What you can do right now to support your child’s immune resilience

Here’s where to start today:

Optimize Vitamin D3 levels – This is one of the most important things you can do! Children with optimal vitamin D levels have significantly lower rates of respiratory infections. Most kids are deficient or insufficient, even when they’re outside all day in the middle of summer, so supplementation with Vitamin D3/K2 liquid or Vitamin D3/K2 caps is often needed.
Give a probiotic daily – Taking a probiotic-a-day can keep tummy troubles and the flu away! In fact, one study found that “Probiotic use could achieve >54 million fewer days of infection, >2 million averted antibiotic courses, and >4 million avoided missed work days” each year! Two specific probiotic strains have been found to reduce the frequency and duration of fevers and colds/flus. These exact strains are found in our Immune Probiotic chewable and Immune Probiotic capsules. Dosage is 1 chew or capsule 2x/day for kids and adults. And don’t forget to eat your fermented foods – sauerkraut, kimchi, kefir, and kombucha are delicious ways to get probiotics naturally!
Get adequate sleep – An increase in sleep actually increases the number of your white blood cells. On the other hand, even a few hours of sleep loss at night increases inflammation in our bodies, making us more susceptible to catching the flu and experiencing more severe symptoms.
Avoid simple sugars and processed foods – Did you know that within 30 minutes of eating simple sugars, your white blood cells’ ability to kill germs drops by 50%? This effect is most noticeable 2 hours after ingestion but remains present 5 hours later!
Use nasal irrigation daily! – Apart from regular hand washing, I believe that daily nasal irrigation is one of THE MOST important things we can do to prevent infections from taking hold. Nasal irrigation with Xlear nasal spray and Xlear nasal spray for kids (saline with xylitol and grapefruit seed extract) can wash away viral particles before they take hold and can prevent many infections from happening in the first place!

Ready to go deeper?

These five strategies are just the beginning. Dive deeper into how to build immune resilience in my articles:

Top Ways to Boost Your Child’s Immune System gives you diet and lifestyle strategies, key supplements with dosing, and immune-supportive herbs for prevention
Pediatrician-Approved Natural Remedies for the Flu provides my protocols for supporting your child if they actually get the flu or other respiratory infections

And if you want my complete integrative toolkit, Part 4 of my book, Healthy Kids, Happy Kids, lays out my exact integrative pediatric protocols for the top 25 most common childhood conditions – including fever, flu/cold, cough, earaches, sore throat, vomiting, diarrhea, sleep problems, and more. You’ll learn how to use diet and lifestyle, supplements, herbs, homeopathy, acupressure, and essential oils with age-specific dosing to help your child when they’re sick, and also when to see the doctor. You’ll also learn when antibiotics may be needed (not as often as you might think), and how to reset your child’s gut microbiome when they are.

As one mom said, “Hands down one of my favorite resources to have around the house when the kids get sick! So much good information in here with actual DOSING for kids according to ages.”

(And if you’re an Amazon Prime member, my book is currently available at a significant discount, so you can grab your copy here to be prepared all winter long: Healthy Kids, Happy Kids

I do hope that this has helped you feel more calm and confident as you navigate this winter season. Please share this article with any mama or papa you know who wants to keep their children healthy through the cold and flu season naturally!

Knowledge is Power!

xo Elisa Song, MD

References

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