As respiratory virus season approaches, the American Academy of Pediatrics has published an evidence-based immunization schedule that includes updated guidance for influenza, RSV, and COVID-19 immunizations for children and adolescents from birth to age 18. The schedule,
"Recommended Childhood and Adolescent Immunization Schedule: United States, 2025," was published in the AAP
Red Book Online, the Academy's clinical guidebook for infectious diseases prevention and treatment.
Since its founding in 1930, the American Academy of Pediatrics has been a
leading voice in vaccine recommendations, creating evidence-based guidance to support pediatricians in caring for children and families. The newly published AAP schedule continues in this tradition. It differs from recent recommendations of the Advisory Committee on Immunization Practices of the CDC, which was overhauled this year and replaced with individuals who have a history of spreading vaccine misinformation.
"The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children and adolescents," said
AAP President Susan J. Kressly, MD, FAAP. "Pediatricians know how important routine childhood immunizations are in keeping children, families and their communities healthy and thriving."
The schedule represents formal recommendations from the AAP for routine immunizations for infants, children and adolescents against 18 diseases. The AAP schedule includes updated recommendations for RSV, influenza, and COVID-19 immunizations for pediatric populations. In addition to the updated recommendations for the three respiratory viruses, the schedule incorporates recent updates regarding pentavalent meningococcal vaccine, the starting age of the Human Papilloma Virus vaccine, and removal of a hepatitis vaccine that is no longer available.
"The AAP urges every insurer to cover all the vaccines that are included in this immunization schedule," Dr. Kressly said. "AAP is committed to working with our partners at the local, state and federal levels to make sure every child, in every community has access to vaccines."
RSV
RSV (Respiratory Syncytial Virus) is the leading cause of hospitalization for babies before their first birthday. It is a virus that affects the lungs and airways and spreads easily through the air and by physical contact with the germs. Immunizations for pregnant mothers and newborns provide antibodies that offer necessary protection.
"Babies who become infected with RSV can get much sicker than older kids because their lungs and airways are so tiny," said
Kristina Bryant, MD, FAAP, a member of the AAP Committee on Infectious Diseases. "There are two ways to help your baby get ahead of this serious respiratory illness. Moms who get the RSV vaccine during their pregnancy can pass important antibodies to their developing baby through the placenta. Or new babies can get an RSV shot for RSV season. Well-timed RSV immunizations help babies stay healthy."
Nirsevimab and clesrovimab are the recommended immunizations to prevent RSV. Both are monoclonal antibody products, which are given to babies for instant protection. Another monoclonal antibody, palivizumab, is a shorter-acting product that is no longer recommended for use.
AAP RSV immunization recommendations:
Immunization for infants younger than 8 months who are born during or entering their first RSV season if the pregnant parent did not receive vaccine during pregnancy, if the vaccination status is unknown, or if the infant was born less than 14 days after the pregnant parent received the vaccine.
Immunization for infants and children 8 through 19 months of age at high risk of severe RSV disease and entering their second RSV season. High-risk infants include children with chronic lung disease, immunocompromise, or cystic fibrosis, as well as other groups.
The Academy's recommendations for RSV immunizations are
published online here and will be published in the November issue of
Pediatrics (online Aug. 19).
Influenza
AAP recommends annual flu vaccines for all children starting at 6 months old, unless they have a medical reason not to be immunized. This helps protect not only the child but also the community—especially during seasons when other viruses like RSV and COVID-19 are also circulating. The Academy's
flu vaccine recommendations and an accompanying
technical report will be published in the October 2025 print issue.
"The flu can be much more serious than just a cold or run-of-the-mill viral infection, especially for children under the age of 5 or those with conditions like asthma or diabetes. It is also something that kids can catch—and spread—easily. An annual influenza immunization helps your child's immune system recognize and resist the virus so they can stay in school, go on playdates and do the things kids love doing," Dr. Bryant said.
Influenza (or the flu) is a viral infection of the nose, throat and lungs. It spreads when an infected person coughs or sneezes and another person breathes in the virus from the air, or when someone touches a contaminated surface then puts a finger in their mouth or nose.
Children who are hospitalized, have serious or worsening flu symptoms, or have health conditions that put them at higher risk for complications should start antiviral treatment for the flu as soon as possible, even if they've been sick for a few days.
The 2024–2025 influenza season was a high-severity season for persons of all ages, according to the Centers for Disease Control and Prevention. The CDC reported 267 influenza-related pediatric deaths through August 2, 2025. Of those, 43.6% occurred in children without a high-risk medical condition.
Historically, up to 80% of influenza-associated pediatric deaths have occurred in unvaccinated or incompletely vaccinated children. Children younger than 5 years, especially those less than 2 years, are especially vulnerable to severe illness and hospitalizations or death due to influenza.
COVID
COVID-19 continues to result in hospitalization and death in the pediatric population. Infants and children 6 through 23 months of age are at the highest risk for severe COVID-19. Given this, the AAP recommends a COVID-19 vaccine for all children ages 6 through 23 months old to help protect against serious illness. Children younger than 2 years old are especially vulnerable to severe COVID-19 and should be prioritized for vaccination unless they have a known allergy to the vaccine or its ingredients.
In addition to the recommendation for all children younger than 2 years, the AAP recommends a single dose of age-appropriate COVID-19 vaccine for all children and adolescents 2 through 18 years of age in the following risk groups:
People at high risk of severe COVID-19
Residents of long-term care facilities or other congregate settings
People who have never been vaccinated against COVID-19
People whose household contacts are at high risk for severe COVID-19
The AAP also recommends the vaccine be available for children ages 2-18 who do not fall into these risk groups, but whose parent or guardian desires them to have the protection of the vaccine. The most updated version of the COVID-19 vaccine that is available should be used. The Academy's recommendations for COVID-19 vaccines are
published online here and will be published in the November issue of
Pediatrics (online Aug. 19).
"We extensively reviewed the most recently available data about COVID-19 risks in kids, as well as safety and effectiveness of available COVID-19 vaccines. It's clear they are very safe for all populations. Among the reasons we decided to move to a risk-based recommendation for healthy older children is the fact that the hospitalization rate for young children and children underlying medical conditions remains high, in line with rates for many of the other vaccine-preventable diseases for which we vaccinate," said
Sean O'Leary, MD, FAAP, chair of the AAP Committee on Infectious Diseases.
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