FluMist vs. a Flu Shot

Doctor giving injection to baby boy (2-5 months)

Science Photo Library - IAN HOOTON / Brand X Pictures / Getty Images

Every child should have an annual flu shot (or FluMist spray) to keep them safe during flu season. However, despite the fact that flu vaccination helps kids avoid getting sick, not all eligible kids get a flu vaccine.

One reason is vaccine hesitancy, which is often rooted in misconceptions about the importance or safety of this immunization for children. Another is that most kids don't like to get a flu shot—or any shot, which can make for an unpleasant doctor visit.

Of course, the health of your child is worth them enduring a flu shot. However, a shot is not the only way to get vaccinated against the flu. The FluMist nasal spray flu vaccine is another effective option, providing protection without any ouch.

Both the traditional flu shot and FluMist offer robust protection against getting sick and spreading the flu to loved ones—and the larger community. Here's what you need to know about the flu shot and FluMist to help you decide which one is best for your child.

Flu Vaccine Recommendations

Since 2010, health experts have recommended that all children aged 6 months and over, and all adults, get the seasonal influenza vaccine each year (whether by injection or nasal spray. There are some exceptions for those who have specific contraindications, but these don't apply to most children.

The FluMist vaccine, which is made with a live attenuated influenza virus, has a few more restrictions on who should use it. If those apply to your child, they should still get a shot.

Two Doses at First

Children between the ages of 6 months and 8 years who are getting the flu shot or FluMist for the first time usually need to get two doses. The second dose is given four weeks after the first.

Some children in this age group have previously gotten the flu vaccine but have not received the two-dose series in one year. They also should get two doses.

Why the Flu Vaccine Is Important

The flu vaccine has been proven to reduce the risk of death, hospitalization, health complications, and illness from the flu. Those that get vaccinated but still contract the flu are likely to have less severe symptoms. Vaccination results in fewer school days missed and limits the spread of the illness among family members.

Most kids who get the flu don't get seriously ill, but some do. Even some otherwise healthy children can have serious complications from flu. And every year, some children die from the flu.

Who Can Have FluMist?

FluMist delivers the vaccine by spraying it into the nose. Both the flu shot and FluMist offer good protection against the flu. However, some children are not eligible for the nasal spray, particularly those under age 2. and its effectiveness compared with the traditional shot varies from year to year.

FluMist is best for healthy children age 2 and up. Children who are at the highest risk of serious complications if they get influenza need to get the traditional flu shot instead.

Children who should avoid FluMist include those who:

  • Have medical conditions including asthma or reactive airway disease, diabetes, chronic heart disease, or chronic lung disease
  • Have weakened immune systems
  • Are younger than age 2
  • Are younger than age 5 and have had problems with recurrent wheezing
  • Are taking aspirin
  • Are allergic to eggs

FluMist vs. Flu Shots

If your child is eligible for either type of vaccine, you can choose either one; there are no big drawbacks to either. it's more about personal preference and convenience.

The flu shot and FluMist don't offer identical virus protection, and each year one may be slightly more effective, depending on which flu strains circulate the most. However, both offer generally similar protection.

Both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) endorse both options. They recommend both the flu shot and FluMist equally and put a priority on getting vaccinated over seeking out either one.

However, there are some differences between FluMist and flu shots that may influence a parent's decision between the two.


In general, FluMist is a little more expensive than a flu shot. However, since it has been around for a while now, most insurance companies pay for FluMist, so your cost may not be any different. Contact your pediatrician's office and/or your insurance company to compare your specific out-of-pocket costs.

Live vs. Killed Viruses

A big difference between FluMist and the flu shot is that FluMist is made with live influenza viruses. They are weakened and won't actually give your child the flu. But this is why FluMist is not for severely immunocompromised people.

Nasal Congestion

Since FluMist is given as a nose spray, some experts think that it may not be as effective if your child is very congested, such as if they have allergies or a cold.


Some parents choose FluMist because it does not contain the preservative thimerosal. Although a preservative-free flu shot is available, it is not as widely available as the regular flu shot with thimerosal, so your pediatrician may not have it.

Misinformation lingers around the safety of thimerosal. However, scientists have debunked the idea of a link between thimerosal and autism. Much research has been conducted to look into this claim, and there have not found any evidence that the preservative causes autism or other developmental issues.

Thimerosal is safe and there is no scientifically based reason to avoid it. If a person is otherwise eligible for a vaccine that contains the preservative, they should get that vaccine.


Some studies have shown FluMist to be less effective than the flu shot. However, other research has found that FluMist works better than a flu shot. Many factors influence whether one or the other will be more effective in any given year—or for a specific patient. The point is that both are effective and offer robust protection against the flu.

The FluMist vaccine gave disappointing results against the 2009 H1N1 influenza strain, and so it was not recommended for use from 2015 through 2017. It was reformulated and returned to recommended use in 2018.

As with the flu shot, the effectiveness of Flumist will vary from year to year. This is because each one includes its own mix of flu strains that are predicted to be circulating, and nature has a way of thwarting the best guesses of the experts.

A Word From Verywell

While it can be tricky to choose between FluMist and a traditional flu shot for your child, the key is that both are safe and effective against flu infection. Either one may provide slightly more protection in any given year, but both work well for most children.

The bottom line is that getting either one is preferable to not getting a flu vaccine at all. Talk to your child's pediatrician if you have questions about which one is right for your child. Then, get them immunized to protect their health and that of those around them.

6 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Vaccines for your children: Vaccine for flu (influenza).

  2. American Academy of Pediatrics. Which flu vaccine should my child get this year?.

  3. Centers for Disease Control and Prevention. Live attenuated influenza vaccine [LAIV].

  4. Nowak GJ, Sheedy K, Bursey K, Smith TM, Basket M. Promoting influenza vaccination: Insights from a qualitative meta-analysis of 14 years of influenza-related communications research by U.S. Centers for Disease Control and Prevention (CDC)Vaccine. 2015;33(24):2741-2756. doi:10.1016/j.vaccine.2015.04.064

  5. Centers for Disease Control and Prevention. Thimerosal and vaccines.

  6. Gianchecchi E, Manenti A, Kistner O, Trombetta C, Manini I, Montomoli E. How to assess the effectiveness of nasal influenza vaccines? Role and measurement of sIgA in mucosal secretionsInfluenza Other Respir Viruses. 2019;13(5):429-437. doi:10.1111/irv.12664

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.