Guidance

Immunising preschool children against flu

Updated 6 October 2023

Applies to England

Those working in the early years sector have an important role to play in raising awareness amongst parents about annual flu vaccination programme for preschool children. This leaflet provides information about the programme and how to order free resources to display or give to parents.

Background to the programme

Flu is a common infection in babies and children and can be very unpleasant for them. Children under the age of 5 have the highest hospital admission rates for flu compared to other age groups.

All children aged 2 and 3 years old (on 31 August before flu vaccinations start in the autumn) are eligible for a free flu vaccination in the form of a nasal spray. However, not all parents are aware of this or take up the offer.

In addition, any child over the age of 6 months with a condition that puts them at higher risk of severe complications if they get flu should also have a free flu vaccine. This includes children with serious breathing problems (such as some children with asthma), serious heart conditions, severe kidney or liver disease, diabetes, immunosuppression or problems with the spleen. Most will have the nasal spray vaccine but it is not recommended for children under the age of 2 years who will be offered an injected vaccine instead

What is flu?

Flu can be a very unpleasant illness in children causing fever, extreme tiredness, aching muscles and joints, stuffy nose, dry cough, and sore throat. Children usually begin to feel better within about a week. Complications of flu include acute bronchitis, painful ear infections, and pneumonia. Some children may need to go to hospital for treatment, including intensive care.

The purpose of the programme

Annual vaccination of children helps provide protection to each child and reduces the spread of flu to their families and the wider community, protecting others who are at increased risk of becoming seriously ill from flu. The flu vaccine also promotes a healthy working environment in nurseries and childcare settings by reducing the risk of flu being spread to others including staff.

Where children can get the vaccine

All children who are aged 2 and 3 years old (provided they were this age on 31 August before flu vaccinations start in the autumn) can get the vaccine at their general practice. This is usually administered by the practice nurse and for most children is a quick and painless nasal spray.

There are some children for whom the nasal spray is not suitable. GP practices will check suitability before offering the vaccine.

When the vaccinations need to be given

Vaccinations need to be given in the autumn or early winter before flu typically starts to circulate. Flu viruses can change every year so the vaccine is usually updated each year. Therefore the vaccine needs to be given on an annual basis.

Can parents refuse to have their child vaccinated?

Yes, the vaccination is not mandatory. Parents will need to give their informed consent for the vaccination.

The nasal flu vaccine contains a highly processed form of gelatine (derived from pigs). For those who may not accept the use of porcine gelatine in medical products, an alternative injectable vaccine is available. Parents should discuss their options with their nurse or doctor.

The role of the early years sector

What staff in the early years sector can do to support the programme

Staff working in the early years sector can help raise awareness of the programme amongst parents. Resources can be downloaded or ordered for free. You may want to display or give these to parents.

Can staff have the vaccine?

Staff with certain medical conditions that put them more at risk of flu, or who are pregnant, are entitled to free flu vaccination (injectable vaccine) through the NHS. Eligible staff should contact their GP practice. Some local pharmacies also provide this service. For more information visit NHS.UK.

Some early years providers may choose to provide an injectable vaccine for their staff through their own occupational health services.

If a child or staff member has flu symptoms

There is no precise exclusion period. Children and adults with symptoms of flu are advised to remain at home until they have recovered

Further information is available in the health protection in education and childcare settings guidance.

Preventing the spread of flu

You can help stop yourself catching flu or spreading it to others with good hygiene measures. The young children that you care for should also be encouraged to do the same:

• wash hands regularly with soap and warm water
• use tissues to cover the mouth and nose when coughing or sneezing
• put used tissues in a bin as soon as possible

Regularly cleaning surfaces such as tables, telephone and door handles can also help to get rid of germs.

Resources

The UK Health Security Agency (UKHSA) has produced the following resources which can be downloaded or ordered for free from the Health Publications website:

• protecting your child against flu leaflet – this leaflet provides information for parents and carers on the flu vaccine, including how it works and contraindications

• Five reasons to vaccinate your child against flu poster – this poster sets out key messages for parents about the flu vaccine

• you can also visit www.nhs.uk/child-flu for further information