What's worse, a shot in the arm or a spritz up the nose? Children increasingly have a choice when it comes to vaccination for influenza.

On Thursday, the Advisory Committee on Immunization Practices, a panel that advises the federal Centers for Disease Control and Prevention on vaccinations, voted for the spritz up the nose. It recommended that healthy children ages 2 through 8 get FluMist, a nasal spray flu vaccine, instead of the traditional flu shot.

But the nation's pediatricians aren't quite so ready to chuck the needle.

Recent studies show that FluMist, which is made with live attenuated influenza viruses, does a better job of prompting an immune response. But because it has live viruses, unlike the flu shot, it's not recommended for people with chronic diseases or people who are immune compromised, like cancer or transplant patients.

That also includes children with asthma, according to Dr. James Perrin, president of the American Academy of Pediatrics.

"Children who get the nasal spray could actually get their wheezing worsened," Perrin told Shots.

Since 9 percent of children, or 6.8 million, have asthma, that means a lot of kids are not going to be getting FluMist if their doctors follow the academy's recommendations.

The pediatricians also recommend that children ages 2 to 4 who have had significant wheezing or a lot of respiratory illness in the past year shouldn't be given FluMist, because they may be on their way to an asthma diagnosis.

What's more, the pediatricians differ with the advisory committee on the superiority of FluMist, saying that they don't think it gives substantially better protection against the influenza virus. Perrin says: "There may be a very slight benefit, but it's not clinically important."

This may come as unhappy news to children nationwide, but Perrin isn't convinced that the nasal spray is that much more pleasant than a shot. "It's not something that children would drive around to get."

Plus shots have become much less painful, thanks to smaller needles and better techniques. "I think we've learned over the years that shots aren't always terribly obnoxious to children," Perrin says. "It's very brief discomfort now."

The advisory committee's recommendation has to be approved by the CDC before it becomes official. And the American Academy will publish an updated recommendation on flu immunizations for children sometime this fall.

So stay tuned.

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