Children and the Covid Vaccine: What Parents Need to Know

May 21, 2021
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Children 12 to 17 are now eligible to get vaccinated against Covid-19. Here’s what we know about giving Covid shots to kids.

Many parents who have eagerly lined up to get vaccinated against Covid-19 still have questions about getting their children the shot. Now that children 12 to 17 are eligible, we’ve answered common questions about young people and the vaccine.

Here’s what you need to know:

The Food and Drug Administration so far has approved only the Pfizer-BioNTech vaccine for young people aged 12 to 17. The vaccine has been approved for use in 16- and 17-year-olds since December, although in most states, eligibility for older teens was delayed until April. In May, children ages 12 to 15 became eligible for the Pfizer shot. Two other vaccines are likely to be approved for children in the coming months. Moderna is testing its vaccine in 3,000 children ages 12 to 17 and may have results for that age group within weeks. Johnson & Johnson in April also began studying 12- to 17-year-olds.

Younger children will probably be eligible this fall. Pfizer plans to seek emergency authorization in September for children between the ages of 2 and 11, and results from Moderna’s clinical trial in children as young as 6 months are expected by the end of the year.

Dr. James Conway, a pediatric infectious disease specialist at the University of Wisconsin School of Medicine and Public Health who oversees vaccination programs there, said vaccines will likely be available for 5- to 11-year-olds in late 2021, and for babies over 6 months, toddlers and preschoolers in early 2022.

The dosage of Pfizer vaccine approved for 12- to 17-year-olds is identical to the dosage approved for adults: two doses of 30 micrograms each given three weeks apart.

It’s possible that when the Pfizer vaccine is approved for even younger children, or when Moderna and Johnson & Johnson complete the research on their vaccines, that the recommended doses may be different than those given to adults.

The Moderna trial, for instance, is studying different dosing strategies in 6,750 healthy children in the United States and Canada. In adults, the standard dose is 100 micrograms given four weeks apart. In Moderna’s study of children aged 2 to 11, the company is testing doses of either 50 or 100 micrograms. In children younger than 2 years, Moderna is studying shots of 25, 50 or 100 micrograms.

Younger adolescents will be able to get the shot in a variety of locations, including their pediatrician’s office. Shots also will be offered at pharmacies and school-based clinics. Check your local health department website or with your pediatrician for details. Some sites may require appointments, while others will offer shots on a walk-in basis. Your area may offer mobile vaccination units in neighborhoods, parks, camps and other places where children congregate.

Many parents are confused about whether they need to time Covid shots with other childhood vaccinations because the Centers for Disease Control and Prevention recently changed its guidance. Previously, the agency said children and adults should wait two weeks before or after a Covid vaccine to receive any other inoculation. The C.D.C. said the initial restriction was a precautionary measure in the early days of vaccine distribution, but now says Covid vaccines and other vaccines can be given without regard to timing.

“Experience with other vaccines has shown that the way our bodies develop protection, known as an immune response, after getting vaccinated and possible side effects of vaccines are generally the same when given alone or with other vaccines,” the C.D.C. says.

The American Academy of Pediatrics issued a statement supporting the change, particularly for children and adolescents who are due for other childhood vaccinations or who have fallen behind the recommended schedule. The C.D.C. notes that if multiple vaccines are administered at a single visit, the injections may be given in different parts of the body.

Fevers were slightly more common in 12- to 15-year-olds compared to adults, but in general, the side effects reported in children have been similar to those seen in older people. The F.D.A. stated that the most commonly reported side effects in the adolescent clinical trial participants were pain at the injection site, tiredness, headache, chills, muscle pain, fever and joint pain. Side effects typically lasted one to three days. Although pain at the injection site was common after both shots, more adolescents reported side effects after the second dose than after the first dose. In general, younger people tend to have a more powerful immune response than older people because they have more robust immune systems. It’s possible that children may experience more side effects than their parents did from the same shot.

Children should not get the Pfizer vaccine if they have a history of severe allergic reaction to any ingredient (such as polyethylene glycol) in the vaccine. Allergies to the vaccine ingredients are rare. You can find a full list of the ingredients here. The vaccine does not contain eggs, preservatives or latex. If you have doubts or aren’t sure, talk to your pediatrician before getting your child vaccinated.

If your child has severe allergies to anything else (medications, foods, bees), plan to remain at the vaccination site after the injection for 30 minutes, instead of the 15 minutes that the general population is recommended to wait.

You should not give your child a pain reliever before getting vaccinated. And don’t give it right after the shot to ward off side effects either. Wait to see if symptoms develop and the child expresses discomfort before giving acetaminophen (Tylenol) or ibuprofen. Studies show that many parents make the mistake of giving children over-the-counter pain relievers right before childhood vaccinations in hopes of reducing side effects. But blunting side effects by pre-medicating can also blunt the effectiveness of the vaccine. If your child develops a headache, body aches or other side effects requiring pain relief, it’s fine to give them the recommended dose of an over-the-counter pain reliever.

The answer depends on whether your child attends public or private school. Private schools, day care centers and camps can decide whether to require students to be vaccinated against Covid-19 as a condition of returning to school or the facility. So far more than 100 colleges have announced they will mandate vaccines before students can head to campus in the fall.

For public K-12 schools, vaccination requirements are largely left up to the states. All 50 states have legislation requiring specified vaccines for students, although no state currently requires children to receive the Covid-19 vaccine as a condition of returning to school, according to the National Conference of State Legislatures. Exemptions to school immunization requirements vary, but all states grant exemptions to children for medical reasons. Children of parents who have religious objections to immunizations can receive a religious exemption in 44 states and Washington, D.C. And 15 states allow philosophical exemptions for children whose parents object to immunizations because of personal, moral or other beliefs.

The Pfizer and Moderna vaccines use something called mRNA technology — the “m” stands for messenger. Think of the mRNA molecule like a set of instructions. While a traditional vaccine uses a weakened or inactivated germ to trigger an immune response in our bodies, the mRNA vaccines carry a set of instructions to teach our cells how to make a protein that will trigger an immune response and produce antibodies to the virus.

Although mRNA technology has been studied for about 15 years, this is the first time it’s been used in a vaccine. It’s also being studied to treat cancer, muscular dystrophy and other diseases.

Dr. Paul Offit, director of the vaccine education center at Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s vaccine advisory panel, notes that while mRNA vaccines are new, mRNA molecules occur naturally throughout the human body.

“Every child in their cells has about 200,000 copies of messenger RNA,” said Dr. Offit. “Every cell in your body has these molecules which are making proteins and enzymes so you can continue to live. Although the technology is new for a vaccine, it’s not like it’s a molecule we haven’t seen before. I understand the anxiety, but it’s no different than when you make insulin or hemoglobin or albumin or any of the other proteins your body makes.”

Here’s how it works. When your child gets the Pfizer shot in the arm, the injection includes the messenger molecule, which is packaged in an oily bubble that fuses to a cell. The cell then uses the mRNA molecule as a set of instructions to make something called a “spike protein,” which protrudes from the cell’s surface. (The surface of the coronavirus is covered with similar spikes.)

A child’s immune system quickly recognizes that the spike protein is a foreign invader, and begins attacking it. The vaccine has essentially trained the immune system to recognize and attack the spike. Now, if your child ever comes into contact with the actual coronavirus, their immune system has learned how to handle it. You can learn more about mRNA vaccines from the Centers for Disease Control and Prevention website.

The study that led to the Pfizer vaccine’s approval for children began in March. The study enrolled 2,260 participants ages 12 to 15. Of those children, 1,131 received the vaccine (two shots, given three weeks apart) and 1,129 received saline placebo shots. The vaccine worked even better in children than it does in adults. No children in the vaccine group got sick with Covid-19, while 18 children in the placebo group became ill. The company is still gathering information, including testing the trial participants every two weeks for the coronavirus.

Beyond the clinical trials, health officials are continuing to gather information on the 3.76 million young people in the United States aged 12 to 17 who have received at least one dose of the Pfizer shot, according to C.D.C. data.

Scientists have only about six months of data on the vaccine in adults and older teens and a few months of data on young children. But given that the vaccine’s mRNA molecule mimics a natural human process, experts say they are confident that the vaccines are safe for growing bodies.

Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York, said that while there hasn’t been long-term research on whether there are lasting side effects of the vaccine, “we also don’t expect any.” She said parents have raised specific concerns about whether the vaccine could affect puberty or fertility, but there’s not a biologically plausible explanation for why the vaccine would have any effect in those areas.

“There has to be some sort of biologic plausibility for why a vaccine or why an immune response could interfere with those things. And there just isn’t,” said Dr. Oliver. “I’m a worrier, and this possibility of unknown long-term side effects from the mRNA vaccines just isn’t keeping me up at night.”

One reassuring fact about the mRNA vaccines is that the molecule is destroyed by the cell once it completes its mission, so it doesn’t stay in the body.

“This is one of the better technologies if you’re worried about something staying in your child’s body,” said Dr. Ibukun C. Kalu, a professor of pediatrics at Duke University. “There’s no way it can become stored in the DNA or trigger some long term cascade that will impact a child’s reproductive organs.”

Another common worry among parents is the effect of a new drug or vaccine on brain development. Dr. Offit noted that the body has a blood-brain barrier that prevents most proteins from entering the brain. “Your brain is an immunologically protected site,” he said.

While children are less likely to develop severe illness from Covid-19, they are still at risk. Nearly four million children in the United States have tested positive for the virus since the start of the pandemic, according to the American Academy of Pediatrics, and more than 300 have died. This past winter, doctors reported growing numbers of patients with Multisystem Inflammatory Syndrome in Children, or MIS-C, a condition linked to Covid which can affect multiple organs, including the heart.

Dr. Megan Ranney, an emergency room physician and professor at Brown University in Providence, R.I., said she had “zero safety concerns” about the Pfizer-BioNTech vaccine, noting that hundreds of millions of people worldwide had received it. Her 12-year-old daughter will get vaccinated, and her 9-year-old son will be immunized when he’s eligible, she said.

“The risk of your child catching Covid and getting really sick is low, but it’s not zero,” said Dr. Ranney. “And the risk of them getting sick or hospitalized or worse with Covid or with the post-Covid multi-inflammatory syndrome is higher than the risk of something bad from this vaccine.”

Currently about 24 percent of the Covid cases in the United States are in young children, said Dr. Offit. He notes that more American children have died from Covid during the pandemic than die annually from other illnesses for which children are regularly vaccinated. About 75 to 150 children in the United States die of flu each year, he said, and about 100 children die of chickenpox.

“If I had to convince a parent, I would bring them into the hospital with me and let them round on our Covid ward to see what this disease looks like,” said Dr. Offit. “There’s every reason to get them vaccinated. If I had a 12- to 15-year-old, I would vaccinate them in a minute.”

Additional reporting contributed by Apoorva Mandavilli, Abby Goodnough, Denise Grady, Melinda Wenner Moyer