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A March 2026 report in AAP News from the American Academy of Pediatrics describes a program at Children’s Hospital Colorado that has offered vaccines—primarily the seasonal flu shot—to more than 18,000 children while they were under deep sedation or general anesthesia for surgery or other procedures since 2020. The goal is to catch up children who miss routine visits or struggle with needles, including some with neurocognitive conditions. Parents receive information and are asked for consent, yet the timing of that conversation and the limited public tracking of any later issues have left open questions about how well the practice balances convenience with clear decision-making.
How the Program Began and What the Numbers Show
Children’s Hospital Colorado started systematically offering the influenza vaccine to eligible patients scheduled for elective general anesthesia in October 2020. An intake nurse checks vaccination status, confirms eligibility, and obtains parental consent before a standing order is placed. The shot is then given after the child is under anesthesia. Early results from a 2021 Healio report showed a sharp rise: only about 30 vaccines were given in a six-week period before the alert system, compared with 1,063 over the next 25 weeks. No vaccine-related complications were reported in that initial window, and families raised few concerns at the time.
By early 2026 the cumulative total at the Colorado hospital had passed 18,000 patients vaccinated under anesthesia, according to the AAP News piece co-authored by Drs. Caroline A. Pasquariello and Kim M. Strupp. Additional vaccines beyond the flu shot are given at the request of a child’s primary care clinician, especially for children with neurocognitive conditions who cannot tolerate shots while awake. Similar efforts exist at Children’s Hospital of Philadelphia, where a program called “Close Your Eyes, We’ll Immunize” delivered 2,054 flu vaccine doses in the 2025–2026 season, and at Lurie Children’s Hospital in Chicago, which began offering the option in October 2026. In each case the children are already scheduled for a procedure that requires sedation or anesthesia; the vaccine is an added step.
Supporters point out that roughly one-third of families at the Philadelphia program said their child would not have received the flu shot otherwise, often because of needle fear, limited clinic access, or vaccine hesitation. Declines, when they occur, are most often because the child already had the shot or the family simply preferred not to add it that day. The American Academy of Pediatrics frames the approach as a practical way to improve coverage without a separate visit.
Consent in a High-Pressure Setting
Sources describe an explicit consent step. At Colorado the nurse asks during preoperative check-in. At Philadelphia, families receive information in advance materials and are asked again on the day of the procedure. Hospital statements emphasize that the vaccine is not given unless the family agrees. A 2021 quote from the Colorado anesthesiologist who helped launch the effort noted that families had “very few concerns.”
Critics of the timing argue that the preoperative window is already stressful. Parents are absorbing anesthesia risks, surgical details, and a child’s discomfort. Adding a vaccine discussion in that moment can feel like one more item on a long list rather than a calm, fully informed choice. The AAP News article itself does not spell out the exact script used with families or how thoroughly side-effect overlap is explained. Some alternative reports highlight a Philadelphia note that “time constraints in the perioperative setting can limit the opportunity for detailed discussions” with hesitant parents. Whether that constraint affects the quality of consent is a point on which the published data remain thin.
For children with significant developmental or behavioral challenges, the program is sometimes presented as the only realistic chance to vaccinate without heavy sedation solely for that purpose. Families who support it describe relief at avoiding a separate, difficult clinic visit. Families who decline cite preference for their regular doctor or concern about combining the shot with surgery.
Side Effects That Can Look Like Surgical Problems
Medical literature has long noted that common vaccine reactions—fever, irritability, rash, prolonged crying—can resemble ordinary postoperative events. A 2010 review in a Society for Pediatric Anesthesia newsletter observed that such reactions “may mimic commonly seen post-operative complications.” The Royal Children’s Hospital in Melbourne states in its guidelines that vaccine side effects “can be similar to postoperative events, possibly confusing the signs of surgical complications.” A child who develops a fever after surgery may normally prompt blood work, imaging, or even a return to the operating room to rule out infection or other problems. If the fever is actually a vaccine reaction, those steps can be unnecessary or can delay recognition of a true surgical issue.
Some professional groups therefore recommend a short gap. A 2026 Japanese consensus statement from the Japan Pediatric Society and Japanese Society of Anesthesiologists advises completing inactivated vaccines at least 48 hours before elective surgery when possible, precisely to reduce diagnostic confusion, while also stating that clear evidence of reduced vaccine effectiveness or increased side effects from perioperative timing is lacking. The Association of Paediatric Anaesthetists of Great Britain and Ireland has offered similar guidance on delaying major elective surgery for 48 hours after inactivated vaccines. These are not absolute bans; they are caution notes that the Colorado-scale program treats as manageable in daily practice.
Early program data from Colorado reported no vaccine-related complications in the first period studied. Broader independent tracking of outcomes specifically comparing children vaccinated under anesthesia versus those vaccinated while awake is not described in the AAP News summary. In routine hospital care, a fever or rash after surgery is usually attributed to the procedure or anesthesia unless someone is deliberately looking for a vaccine link. That gap in dedicated follow-up is one of the points alternative coverage has emphasized.
Revenue, Scale, and the Shift from Exception to Routine
Hospitals bill for vaccine administration. Reports on the Philadelphia program noted that it generated more than $60,000 in one season; that figure is consistent with normal reimbursement for thousands of doses rather than evidence of improper motive by itself. At Colorado the volume—more than 18,000 children over roughly five years—moves the practice beyond the occasional case of a needle-phobic child. Once a best-practice alert prompts staff to offer the shot to every eligible patient, the exception becomes the default workflow.
Scale also multiplies the diagnostic-overlap concern. If even a small percentage of children develop a fever or other reaction that is later investigated as a possible surgical complication, the absolute number of extra tests or delayed diagnoses grows with the number of vaccinations. No public data set from the Colorado program has quantified how often that confusion occurred or how it was resolved. Proponents counter that the overall benefit of higher vaccination rates outweighs the theoretical risk, especially for children who otherwise remain unprotected during flu season.
What the Available Evidence Does and Does Not Answer
The published record shows a large increase in flu shots given during procedures that already require anesthesia, parental consent obtained at the time of check-in or on the day, and no complications flagged in the early Colorado reports. It also shows that some children with neurocognitive conditions receive additional vaccines under the same conditions at a primary clinician’s request. What is not available in open summaries is a detailed breakdown of adverse-event rates specific to this setting, a comparison of post-procedure outcomes between vaccinated and unvaccinated surgical patients, or a description of how often vaccine reactions were formally distinguished from surgical ones.
Readers weighing the practice can look at both the stated intent—to reach children who face real barriers to routine care—and the practical limits of consent and monitoring when the offer is embedded in a high-volume surgical day. Similar questions appear in broader discussions of vaccine programs and hospital protocols; for related reporting on childhood vaccine data and outcomes see coverage such as Child COVID Shots Tied to 60% Higher Mental Care Odds and The COVID Reckoning That Never Came. Hospital-level decision patterns are also examined in pieces like COVID Hospital Protocols: What 583 Families Told a Senator.
Parents facing a scheduled procedure can ask in advance whether the hospital will offer a vaccine that day, what exact information will be provided, and how any later fever or rash will be evaluated. They can also request that the decision be discussed with their regular pediatrician before the surgical day. The AAP report presents the Colorado and Philadelphia programs as successful models. Independent accounts note the volume, the consent setting, and the absence of detailed safety comparisons. Both descriptions rest on the same underlying facts; the difference lies in which details each chooses to emphasize.
Original Source and Disclaimer
Primary source: Pasquariello CA, Strupp KM. “How to make immunizations part of pediatric surgical, procedural care process.” AAP News, American Academy of Pediatrics, 9 March 2026. https://publications.aap.org/aapnews/news/34598/How-to-make-immunizations-part-of-pediatric
Disclaimer for readers and fact-checkers: This article summarizes publicly reported details from the AAP News piece, earlier Healio and hospital communications, and related professional guidelines. The American Academy of Pediatrics is a long-established professional organization. Alternative outlets have interpreted the same numbers through a more critical lens. No claim of wrongdoing or proven harm is made here beyond what the cited sources themselves state. Readers should consult the primary documents and their own physicians for medical decisions.