As if kids don't already suffer through enough vaccinations -- the seemingly endless alphabet soup of DTaP, Hib, MMR, Hep B and IPV -- doctors want to add more: flu shots.

For now, though, the suggestion for annual childhood influenza vaccinations is a mild nudge, not a strong push.

Both the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention are encouraging all children ages 6 months to 23 months be vaccinated against the flu.

Flu shots have long been recommended for children of this age who have chronic conditions like asthma, heart disease, HIV, sickle cell disease and diabetes. What's new this year is that the CDC and pediatrics academy are ``encouraging'' flu shots for healthy children 6 months to 23 months old.

Plus, the academy is pointing out that a flu shot ``can be administered'' to any child older than 6 months.

Note the semantics: Flu shots are ``encouraged'' for healthy infants, are ``recommended'' for those with underlying disease and ``can be'' given to any child older than 6 months, healthy or not.

Dr. Blaise Congeni, director of infectious diseases at Children's Hospital Medical Center of Akron, suspects these word choices are a way to grab the public's attention before pushing for major change.

``I think the difference between `encourage' and `recommend' means, `We're phasing it in, get ready.' ''

That leaves the parent of an average, healthy toddler, grade-schooler, adolescent or teen using his or her own best judgment.

``I don't have a blanket answer of, `Yes, if you have a child, you have to come in and get it.' I kind of leave it up to personal choice,'' said Dr. D. Douglas Hackenberg, president of Children's Medical Group in Akron. ``I try to educate parents about the pros and cons of the flu vaccine. If they say they want it, I'm more than happy to give it. If they don't want it, I'm not going to push it.''

Still, both Congeni and Hackenberg see childhood flu shots as beneficial, especially for all children 6 months to 23 months, an age group that is very likely to require hospitalization with the flu.

Plus, children are far more likely than adults to get influenza each year. The virus hits about 40 percent of kids, compared with 11 percent to 20 percent of adults.

Beyond that, Hackenberg points out that the vaccination will keep children from missing school and parents from missing work. And, Congeni says, studies have shown that vaccinating children keeps adults healthier because the virus is less likely to spread.

There are side effects to flu shots, though. Most are mild, like fever, aches and soreness, redness or swelling where the shot was given. Those with allergies to eggs can have life-threatening reactions, though that's rare. And in about one or two cases per million, the flu shot has been linked to Guillain-Barre syndrome, which leads to temporary paralysis.

But the most obvious down side to childhood flu shots, Congeni said, is that it's another shot that requires another trip to the doctor's office.

In fact, for children younger than 9, their first flu vaccination will require two trips to the doctor's office, four weeks apart. (The CDC suggests the first dose be given in mid- to late October to allow the timing of the second dose to come before peak flu season in December.)

Unlike in the recent past, this flu season there's an abundant supply of vaccine, with about 93 million doses available nationwide.

Despite a 25 percent increase in price -- from $4.49 to $5.64 -- the Ohio Department of Health already has its total supply of 280,000 doses, though those doses are reserved for people considered high-risk -- those over 50; residents of nursing homes or long-term care facilities; adults and children older than 6 months who have chronic heart disease, chronic lung conditions (including asthma), diabetes, chronic kidney disease, or weakened immune systems; children and teen-agers (6 months to 18 years) who are on long-term aspirin therapy; andwomen who will be more than 3 months pregnant during the flu season.

Because the Ohio Department of Health is limiting its stock to high-risk individuals, healthy people younger than 50 will have to get their flu shots somewhere other than local health departments. And that includes the healthy 6- to 23-month-olds the CDC is targeting.

``The CDC is really encouraging flu shots for healthy toddlers, but we really don't have enough vaccine for that,'' said Ann Morse, nursing supervisor for the Summit County Health Department. ``There's enough vaccine out in the community if people want to do that.''