Kids and the COVID-19 vaccine — Updated guidance and info

A reduced dose of Pfizer’s COVID-19 vaccine has been approved for children ages 5 to 11 years old. This is an exciting development in the continued fight against the coronavirus and COVID-19 pandemic.

The recent delta surge had a significant impact on children and showed us that kids are among those at risk for serious illness from COVID-19. The vaccine will help protect children, keep schools open, and is an important step in our ongoing work to address COVID-19 in our communities.

What does this mean for kids and standard vaccine schedules? Are side effects similar for kids as they are for adults? Will schools require the vaccine?

Mary Fairchok, MD, medical director of pediatric infectious diseases at Mary Bridge Children’s, and the medical director of infection prevention at MultiCare, spoke previously about kids and the COVID-19 vaccine, and shares her thoughts on the latest updates for this younger patient population.

Who qualifies for the vaccine?

Both the FDA and the CDC’s Advisory Committee on Immunization Practices (ACIP) recommend that all children 5 years old and up get the Pfizer COVID-19 vaccine.

The vaccine is authorized under an Emergency Use Authorization (EUA) from the FDA for children between ages 5 to 11 years old to get the new 10 microgram dose. The Pfizer vaccine is also authorized under EUA for children between 12 and 15 years old to get the full 30 microgram dose.

The Pfizer vaccine is fully approved by the FDA for those 16 years old and older.

Will the dose for children 5 to 11 years old come from the same vaccine supply/vials?

No. The Pfizer dose for children 5 to 11 years old is packaged differently, with the appropriate dosing, which is lower than what is used for those 12 and older. The lower dose was intentionally chosen to further reduce any side effects, and studies showed it to be effective in protecting children against infection.

When will younger kids be eligible?

Clinical trials are still being conducted for children under 5 years old. When those are complete, if shown to be safe and effective, we anticipate the COVID-19 vaccine will become more widely available with additional EUAs.

If my child already had COVID-19, do they still need to be vaccinated?

Yes. Like adults, it is recommended that children get vaccinated against COVID-19, regardless if they’ve already had the virus. There is still not enough information about how long immunity lasts after being sick with COVID-19, so it is important that your child receives the vaccine even if they’ve already had COVID-19. Reinfections can and do happen and can be more severe than the first infection. Several studies indicate that unvaccinated people with a previous infection are two to five times more likely to become infected than patients who have been immunized.

I’m worried about short- and long-term side effects. What do I need to know?

“It’s understandable that parents have hesitations about the possible side effects of the COVID-19 vaccine,” Dr. Fairchok said. “This vaccine was not tested in children until it was shown to be safe and effective first in adults and then in older children. Short-term side effects in children who have received this vaccine are similar to adults — fatigue, fever, chills, sore arms lasting a few days — but happen less frequently than in adults. Very rare side effects would not be detected in the clinical trials, but over 245 million doses of Pfizer have now been given to adults and older children in the US alone, and the only serious rare side effect that has been found is myocarditis, (inflammation of the heart), mostly in young adult males. The myocarditis has not caused any deaths, and occurs at least four times less often than myocarditis caused by the virus in young adult males.”

The FDA and CDC considered the possibility that myocarditis may be also rarely seen in young children, but still decided that the risk is much lower than the risk of the disease itself. Rare side effects will continue to be monitored as millions of children are now receiving the vaccine. It’s important to note that while additional rare side effects may be detected as vaccines continue to be given more widely, known side effects of the disease itself would still be much more likely to occur.

Long-term side effects not seen within a few weeks are not a concern for several reasons. Our bodies process this vaccine very quickly. Unanticipated vaccine side effects show up within weeks after vaccination, not years. Finally, with the billions of doses of vaccine having been given worldwide over the past year, we have powerful proof that there is very little chance that any new, unexpected dangers will be found to occur months after immunization.

“On the other hand,” said Dr. Fairchok, “Infection with COVID-19 is now well known to cause long-term side effects including brain fog, chest pain and shortness of breath, heart disease, dizziness and more in up to 20 percent of people, including about 8 percent of children. The Pfizer vaccine has been shown to be both very safe and effective.”

It’s OK to administer child-approved pain relievers if short-term symptoms occur. Parents should monitor side effects and be in touch with their child’s pediatrician if the side effects linger.

Should I prioritize my child’s standard shots or the COVID-19 vaccine?

It is important to protect your child and we recommend making sure they’re current on all childhood immunizations, according to standard pediatric immunization schedules. If a choice has to be made, it is better to prioritize your child receiving the COVID-19 vaccine first because we are still in a pandemic situation.

The COVID-19 vaccine is safe to get at the same time as other routine vaccines, including the annual influenza vaccine.

Will the COVID-19 vaccine be required for daycares and schools?

At this time, the COVID-19 vaccine is not required for children to attend daycare or school in Washington state.

Where can I get my child vaccinated and how do I schedule an appointment?

You can get your COVID-19 vaccine anywhere it is available, including many community locations, retail pharmacies and pop-up clinics. The important thing is to get the vaccine.

Use this vaccine locator tool to find a location near you.

MultiCare and Mary Bridge Children’s are currently finalizing operations and awaiting vaccine inventory to be able to offer COVID-19 vaccines to children ages 5 to 11. Please check MultiCare’s COVID-19 vaccine page for updates. Vaccines will be available by appointment for children who are established patients with a MultiCare or Mary Bridge Children’s primary care provider.

This blog post was originally posted on May 20, 2021 and was updated on Aug. 27, 2021, and Nov. 8, 2021.