November is here, and with it comes the annual parade of sniffles, fevers, and worried parents in our exam rooms. But this year, the viral season feels especially layered. We’re not just worried about bracing for influenza and RSV— we’re also navigating a new chapter in COVID vaccination, including a notable shift in pediatric recommendations from the American Academy of Pediatrics (AAP).
So how do we counsel families clearly and confidently, especially when the rules are changing? Let’s break it down.
Back in August 2025, the AAP released its own updated immunization schedule, published in the Red Book Online. While it’s not unusual for the AAP to publish its own schedule, this time its recommendations diverged significantly from those of the CDC.
Why the shift? Here’s the backstory:
Traditionally, the process goes like this: the FDA licenses vaccines → ACIP (Advisory Committee on Immunization Practices), a branch of the CDC, makes recommendations → and insurance companies (including the Vaccines for Children program, or VFC) follow suit.
In 2025, all 17 ACIP members were replaced. The CDC also removed advisory roles from major medical organizations including the AAP and AAFP (American Academy of Family Physicians). In response, these groups, along with ACOG (American College of Gynecology), began developing their own collaborative, evidence-based guidance.
The AAP’s independent panel includes vaccinologists, infectious disease experts, and study design pros—and they haven’t shied away from making clear recommendations.
The most significant point of departure between schedules this year? COVID-19 vaccination for children.
The CDC says pediatric vaccination should be based on shared decision-making.
The AAP recommends routine COVID vaccination for all children ages 6-23 months, and for children ages 2-18 years who are either high-risk or whose families opt-in.
Why the strong stance from the AAP?
No new safety signals have emerged.
Evidence shows that COVID vaccines are effective at preventing severe disease and reducing post-COVID sequelae.
Children under 2 years remain among the most hospitalized age groups for COVID.
Even if a child completed a primary series last year, the AAP recommends a single updated dose this season for those 6-23 months old.
For kids ages 2-18 years, the recommendation is more nuanced—one dose is recommended if they are high-risk (e.g., have asthma, epilepsy, immunodeficiency, or are living in long-term care), have never been vaccinated, live with high-risk individuals, or if parents simply prefer to vaccinate. Immunocompromised kids may need more than one dose; consult the Red Book for specifics.
The flu vaccine guidance for this season mirrors last year’s in many ways, with one key update: The 2025-2026 trivalent vaccine includes a new H3N2 strain, reflecting global surveillance data.
Last flu season was labeled “high severity” across all age groups—something we haven’t seen since 2017-2018. Pediatric groups at highest risk remain:
Children under 5 years (especially those under 2 years)
Children with chronic health conditions, including obesity
The AAP recommends that everyone 6 months and older receive the flu vaccine as soon as it’s available. For families with access issues, home administration of the live attenuated intranasal vaccine (LAIV) is an option for eligible children ages 2 years and older.
This is the first full season without palivizumab (Synagis) as the go-to option. Instead, we have two different monoclonal antibodies:
Nirsevimab (Beyfortus)
Clesrovimab (Enflonsia)
But here’s the catch: only nirsevimab is approved for second-season use.
Clinical guidance on which patients need protection, and when, continues to evolve, so it’s important to stay tuned and check local availability and guidelines. But if your young patients qualify, these monoclonals offer a major step forward in RSV prevention.
Here’s the good news:
We have more tools than ever to protect kids
The AAP’s guidance helps center the conversation on safety, efficacy, and clinical evidence
And perhaps most importantly, as a pediatric clinician you have the trust of families navigating these decisions
Lead with that trust. Offer clear, confident guidance. And don’t forget to take care of yourself, too. Because this triple virus season may be intense, but with teamwork, transparency, and solid evidence, we’ve got this.
Want to learn more? Check out our recent Peds Reviews and Perspectives episode, "AAP Immunization Schedule," where we break down these updates with real-world strategies for your clinic.