Increasing use of influenza vaccine in children is expected as this important virus becomes more widely recognized as a major cause of morbidity in young children. Clinicians and third party payers must consider the implications of national vaccine use recommendations, with their current focus on young children, on their practices and on the community at large. Two influenza vaccines are available in the United States, an inactivated, trivalent intramuscular formulation (TIV) which is approved for use among children > or =6 months of age; and a live, attenuated intranasal trivalent preparation (LAIV) indicated for healthy persons 5 to 49 years of age. This review summarizes available data regarding the safety and efficacy of TIV, in comparison with LAIV, with particular attention to children <9 years of age, the population for whom two doses of vaccine are recommended for first time vaccination. It is apparent that relatively few data are available on the safety of TIV in young children, that important age-specific differences in TIV vaccine efficacy exist and that LAIV appears similar to TIV with regard to safety and efficacy in younger children, but no head-to-head comparison of these two licensed products is available.