There have been many rumors about the COVID-19 vaccine, and, of course, no one wants to do anything that could put their child at risk. For any parent with questions, this information will help ease your mind about vaccinating kids.
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When the FDA authorized the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 through 11 last October, many parents were relieved that their kids could finally get the shot. But according to a Kaiser Family Foundation poll, one third of parents said they'd wait to see how things go with other kids before getting their own child vaccinated, and another 30 percent said they won't vaccinate their child at all. Some of the reasons parents gave for their hesitancy included worries about long-term effects of the vaccine, side effects their child might experience, and the possibility that the shot might affect their child's future fertility.

Most parents and their children have a lot of experience with vaccinations already: By age 2, more than 90 percent of American kids are vaccinated against chicken pox, polio, hepatitis B, and measles, mumps, and rubella. Health experts say we should view the COVID shot the same way we view those other necessary vaccinations, yet at press time, only about 17 percent of kids ages 5 to 11 had received their first COVID shot.

All parents want what's best for their children, so we asked pediatricians and infectious disease specialists, who have devoted their careers to keeping kids healthy, to answer a few questions.

If kids are less likely to get seriously ill from COVID, does my child really need the vaccine?

There are many reasons why vaccination is a good choice for your child. While many COVID infections in children are mild or asymptomatic, others are serious. More than 7 million children have tested positive for COVID, and more than 700 have died. "Between 30 and 40 percent of children who wind up in the hospital with serious COVID have no underlying risk factors," says Parents advisor Yvonne Maldonado, M.D., chair of the Committee on Infectious Diseases for the American Academy of Pediatrics (AAP). Even mild or asymptomatic cases can have long-term effects. In addition, kids play a crucial role in protecting others, including immunocompromised children and older people who are still at risk for serious illness or death from COVID, and as a society, we can all do our part.

Another important reason to vaccinate is to protect kids' overall well-being. The pandemic has taken a toll on kids' mental and emotional health, causing anxiety, depression, loneliness, grief, and even suicidal thinking. Being vaccinated can help them get closer to normal life by letting them safely do regular kid things, like see their friends, attend birthday parties, go to camp, and participate in sports, says Parents advisor Jennifer Shu, M.D., a medical editor of the AAP's website HealthyChildren.org.

How exactly is this vaccine different from the one for adults?

It's one third of the adult dose, and smaller needles are used to give the shots to kids. The vaccine works similarly to ones your child has had before. When someone gets an infection for the first time, the body remembers the infection to help protect against it in the future. The COVID vaccine contains messenger RNA (mRNA), which prompts the body to make a piece of protein that looks like the COVID virus but is only a harmless piece of the virus, says Aaron Milstone, M.D., a pediatric infectious disease specialist at Johns Hopkins Children's Center. The body identifies the virus protein and reacts to it by producing antibodies that protect a child as if they'd been exposed to the real virus. The vaccine does not contain live virus and won't give a child COVID, Dr. Milstone explains.

The vaccine can't alter someone's DNA, and it never enters a cell nucleus, where DNA is located. There's also no evidence that the vaccine causes fertility problems in adults, and experts are confident it poses no risk to a child's fertility in the future. One final thing: The science behind COVID vaccines wasn't rushed. Yes, they're new, but researchers have been studying mRNA technology and other mRNA vaccines for decades.

Doctors say all kids ages 5 and older should be vaccinated against COVID. The only ones who shouldn't receive it are those who have an allergy to a vaccine ingredient, which is extremely rare, or who had a severe reaction to a prior dose of the COVID vaccine, Dr. Milstone says. If you have concerns, the best thing to do is to talk to your pediatrician or provider about whether your child should get it. At press time, Pfizer was the only vaccine authorized for kids ages 5 to 11. Clinical trials are underway now to determine the vaccine's safety and effectiveness for children ages 6 months through 4 years old. And Moderna vaccines for children and adolescents are also being evaluated. Experts say both the Pfizer shot and the Moderna vaccines for younger kids may be authorized in the coming months.

How do we know that it's safe for kids?

In clinical trials that monitored approximately 3,100 children, the Pfizer vaccine was found to be safe for kids ages 5 to 11, and it had to meet rigorous scientific standards for safety and effectiveness to gain authorization by the FDA. In addition, almost 8 billion doses of the COVID vaccines have been given worldwide to adults since December 2020, to kids ages 12 and up since May 2021, and to kids ages 5 and up since November 2021. Says Dr. Shu, "That's reassuring, because if there's going to be a side effect from a vaccine, it typically shows up either immediately, within the first day or two, or by six to eight weeks afterward."

It's also helpful to know that, due to the immense publicity and media attention surrounding the authorization of the COVID vaccines, they have been (and will continue to be) monitored more closely than any in history, says Stanley Spinner, M.D., vice president and chief medical officer at Texas Children's Pediatrics, in Houston. There are several safety monitoring systems in place, including the Vaccine Adverse Event Reporting System (VAERS), which is managed by the FDA and the Centers for Disease Control and Prevention (CDC). VAERS allows anyone (patients, parents, health-care workers, pharmacists, and vaccine manufacturers) to report side effects or potential illness after vaccines.

Isn't there a chance it can cause heart problems?

No children in the trial for the 5-to-11 age group experienced a heart problem. There have been reports of some adolescent and young adult males experiencing myocarditis or pericarditis, an inflammation of the heart muscle or outer lining of the heart, usually after receiving the second dose of the vaccine. However, this is extremely rare (about 12 to 25 cases per million doses given). Most heart issues have been very mild, including slight chest discomfort or an elevated heart rate that went away after a few days, Dr. Spinner says. COVID itself can cause severe cases of myocarditis and pericarditis.

What are the immediate side effects?

The lower dose of the vaccine—and maybe kids' strong immune systems—seem to be producing fewer or milder side effects than the adult version. When they do occur, they may include soreness at the injection site, headache, fatigue, muscle pain, and chills. Side effects usually happen within the first couple of days and go away shortly after. Experts advise against trying to prevent symptoms by giving your child pain medication before the shot. If your child takes those medications regularly for some other reason, continue with their normal regimen. Otherwise, hold off until after symptoms (if any) appear. It's not known if giving these medicines beforehand might affect the body's response to the vaccine, Dr. Shu says.

My kid already had COVID. Doesn't that mean they're immune?

No, people can get COVID after they've already had it. According to a CDC study, people who've had COVID and were unvaccinated were more than twice as likely to get reinfected compared with someone who was fully vaccinated after initially contracting the virus. Although a previous infection may offer some protection, experts aren't sure how long it lasts. Furthermore, if your child has had COVID, getting them vaccinated should give them an added immunity boost. A small study published in JAMA Network Open found that people who had a previous COVID infection and got vaccinated had higher levels of antibodies than someone who was vaccinated and never had COVID.

My 5-year-old is small for their age. How do we know this dose is safe for them?

Vaccines are usually given based on the age of a child, not weight—even for all the other vaccines your child has taken over the years, says Dr. Maldonado. So yes, the vaccine is safe even if your child is on the smaller (or larger) size for their age.

My child is 11. Should I wait until they turn 12 and get the adult dose?

No, don't wait. Get your child the age-appropriate vaccine as soon as possible. "With vaccines, it's a balance between immune response and adverse reaction," Dr. Milstone says. "You want to give enough to generate a good robust immune response but not so much that you have more or stronger symptoms after vaccination," he explains. Kids age 11 respond very well to the lower dose, so there's no reason to delay vaccination for the higher dose. If you wait, there's a chance your child might get COVID before they turn 12.

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Will having my child vaccinated help us get back to our prepandemic lives?

In some ways, yes. According to the CDC, once someone is fully vaccinated (two weeks after their second dose of the Pfizer vaccine), they can resume prepandemic activities like playdates and group activities. If your child is vaccinated, it means they'll have a shorter (or no) school quarantine should they be exposed to COVID. And if your whole family is vaccinated and traveling within the U.S., you probably won't have to quarantine after travel.

With all that said, since there have been cases of people getting COVID after vaccination, along with concerns about new variants of the virus, you should still take precautions to reduce your child's chances of getting the virus and possibly spreading it to others. Kids should wear a mask indoors in public spaces in areas with substantial transmission risk. They should wear a mask when traveling (whether on the school bus, on public transportation, or at the airport). And for now, children should pay attention to local rules about wearing a mask in school.

Although masks will be around for at least a little while longer, getting your child vaccinated really can make daily life more like what it used to be. Dr. Shu's daughter, who was 10 at the time, participated in a COVID vaccine clinical trial. All the other members of Dr. Shu's household had been vaccinated already, so getting her youngest child the shot brought their family a step closer to normalcy. "It made me less nervous about taking her out to public places like stores; I feel more comfortable when we're flying; we no longer make her wear a mask outside to play soccer; and when we go to visit family, I feel more comfortable knowing she's not going to inadvertently infect my elderly parents," Dr. Shu says. Another benefit is the sense of relief she got knowing she did what's best for her child. "There are always concerns when you make health choices for your kids, but the choice was clear to me," Dr. Shu says. "It was either I give my kids the vaccine or they potentially get COVID. I know the risks from COVID are much worse, so I wasn't willing to take that chance."

This article originally appeared in Parents magazine's January/February 2022 issue as "Why Holding Off Isn't the Answer." Want more from the magazine? Sign up for a monthly print subscription here

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