Little kids and the covid vaccine

Ask the Doctor: The COVID vaccine and your 5 to 11 year-old child

*Story updated in June 2022 to include information about the booster shot for children ages 5-11.

When the Food and Drug Administration and CDC approved Pfizer’s COVID vaccine for use in children ages 5-11, it was a moment many parents rejoiced in. But, we also know there were many of you who had some serious questions.

Related: Ask the Doctor: Should my baby and toddler get the COVID vaccine?

And you might STILL have concerns many months later after a booster dose for kids in that age group was recommended. And that’s okay.

COVID vaccine doses and kids ages 5-11

Pfizer’s COVID vaccine for kids ages 5-11 is two initial doses, spaced three weeks apart with full immunity taking hold two weeks after the second dose AND then a booster 5 months after the second dose.

It is important to point out that a child’s Covid vaccine dose is smaller than the adult and teen dose at 10 micrograms compared to the 30 micrograms adults and teens receive.

According to the American Academy of Pediatrics, more than 23 million children ages 5 to 17 have received two doses of the COVID vaccine as of June 8, 2022. But, an additional 26 million kids in this age group have not yet received any doses.

While the Covid vaccine may not prevent your child from getting symptoms, doctors say it can help prevent a more serious illness and hospitalization, along with preventing ‘long Covid’ that kids can suffer from. This is why the vaccine is recommended for kids.

Where to book an appointment to vaccinate your 5-11 year old child in Tampa Bay.

You can book appointments for your child to get their COVID-19 vaccine right now through the pharmacies at CVS, Walgreens, Publix and Walmart or even local health department.

Another option is to call your child’s pediatrician to see if they are administering the vaccine–this is a good option for anyone who may want to have a face to face conversation the pediatrician first.

To help answer some of the common questions out there, we’re turning once again to Dr. Christina Canody, director of the pediatric service line at BayCare and Dr. Allison Messina, the chief of the Division of Infectious Diseases at Johns Hopkins All Children’s Hospital to get answers for you.

*Interview edited for clarity and length.

Related: Your Teen and the COVID Vaccine: What parents need to know

A booster shot is now available and recommended for children ages 5-11. Is it really necessary for me to schedule a booster appointment for my child since Covid doesn’t seem to really impact kids as much?

Dr. Canody (added 6/21/22): We know that Covid vaccines do help with the symptoms and they do help prevent it from becoming more severe in children. We are recommending the vaccines and we are recommending booster for those over age 5. It is recommended if it’s been at least 5 months.

I’ve been recommending to families that if your child received the Covid vaccine last year. It’s going to be like influenza where it’s going to be recommended they get a yearly vaccine.

So it’ probably a good idea if you area traveling, if your child is going to be in summer school or summer camp; it’s important they get boosted and maintain that immunity, but also if not this summer then before they head back to school this fall.

What are the side effects of the Covid booster shot in kids?

Dr. Canody (added 6/21/22): Really the biggest side effects are a sore arm, a little malaise and a low grade fever are the main things we’ve heard. We just haven’t seen the severe side effects. We’re not discounting anyone who did have a reaction to it. As you know, kids or adults can have a reaction to any vaccine

We know there is hesitation among some parents about the COVID vaccine for their children since it’s a new mRNA vaccine they’ve never received before. What would you tell parents who are concerned about the COVID vaccine technology?

Dr. Canody: So Pfizer is the only vaccine approved for ages younger than 18. We’ve been giving the Pfizer to 12 to 17 year olds now for right over 6 months and this is the next step in their dosing for younger kids. This vaccine received emergency use authorization on Tuesday (November 2, 2021) at 5:07 pm—I took a picture when they put up the recommendations for 5-11 year olds.

The things that are different about this vaccine is that it is a lower dose than those 12 and up will receive. The full dose for adolescents and adults is 30 micrograms. This is only a 10 microgram dose.

This is a different vaccine. An mRNA vaccine uses a messenger mRNA to actually code immunity against the virus.

What’s important to know is that children, especially younger children, have a more active immune response for vaccinations and so in general, vaccines over the age of 7 have changed. So, when you get a certain type of tetanus vaccine when you’re a little kid, once you hit the age of 7, it has a different amount of ingredient in it just because of the way we react.

The other part of our immune system—the T-cell immunity is a little bit different as well in that it’s much more active in younger children. So the combination of those two factors together allows the for this lower volume and lower dose of this vaccine to be just as effective.

And what’s really interesting is in the preliminary studies of over 2,200 kids enrolled in the trials through Pfizer, and that’s the data that was reviewed by the FDA and ACIP—and what they found was the immune response after two doses of the vaccine in a younger child with the 10 microgram was just a little bit higher and than a 15-year-old given two doses of the 30 micrograms.

In the 5-11 age range, the vaccine was 91% effective in complete prevention of symptomatic infections, so no symptoms whatsoever.

Dr. Messina: Sometimes people raise the concern, well—isn’t that bizarre that you are introducing mRNA to my cells? I always have people remember that when you get sick with a virus, viruses always introduce their mRNA into your cells. They introduce a lot of mRNA.

They introduce enough mRNA that it makes an entire virus. So, if you’re afraid of the vaccine because you are afraid of the exposure to mRNA, you are getting mRNA in spades if you actually get COVID the disease so there’s really not a lot of difference between how your cells process the mRNA that the vaccine gives you vs the virus except and this is a very important except that the vaccine only contains just that little portion, it doesn’t contain the whole virus.

And if it doesn’t contain the whole virus, it’s not going to make you sick because it doesn’t replicate. All it does is give you a little bit of that protein so you can make antibodies to it.  

Another thing that should make this less of a concern is that the 5–11-year old’s are getting this vaccine after literally millions of and millions of people have already received it. And there have not been any serious safety signals that have been seen. 

There are still people who are skeptical about how quickly the COVID vaccines were developed. What do you tell families who express concern about the speed at which the COVID vaccine was released?

Dr. Canody: It’s important for families to know mRNA technology has been around since about 1990, so it’s been over 30 years and it’s been used especially in targeted and brain cancers where there are very specific cells to limit, so it’s a very targeted therapy.

There is a lot of research and information. And just when you put unlimited dollars, unlimited resources, and very smart people together you can come up with a vaccine pretty quickly and obviously this was not rolled out quickly in children. It took almost a year for it to come out in younger children and they wanted to make sure it was safe.

Kids come in all shapes, sizes, and weights. Should a smaller 5-year-old not receive the COVID vaccine quite yet and on the flip side, should a larger 11 year-old opt for the dose teens and adults receive? 

Dr. Canody: There was a diverse group of children ages 5 through 11 that were included in this study and just as well of a diverse group of weights in there. Based on the study data, there was really no difference in the weight-based dosing or in age-based within that realm. They truly looked at the response rate and any side effects that were found. In general the side effects were even lower than in teenagers.

And when it comes down to weight, it really truly has to do with your immune system function. It’s one thing when you are talking about metabolizing an antibiotic and dosing it based on weight and it’s another thing when we are looking at immune function.

We know that throughout childhood and adolescence, the immune system takes different steps. So we know there’s one step when they hit that two month old age when the blood-brain barrier gets thicker, they hit another step around 6 months of age. They hit another step around 2-2.5, a little bit more around 5 and then again early on in adolescents. Somewhere between 10 and 12 and then we truly move into an adult immune system by age 15 to age 16.

If a child already had COVID or recently recovered from COVID, should they wait to get the vaccine or not get it at all since they have a degree of natural immunity?  

Dr. Canody: The recommendation is to wait at least 2 weeks after children are symptomatic  –they do have more robust immunity in those first few weeks to months after the infection, so for most families we say wait at least 2 weeks from the complete resolution of symptoms. Now, if somebody still has loss of smell or taste, that’s not a resolution of symptoms, those are still post-COVID or what we call long COVID symptoms, but in general once they’ve resolved after two weeks, it’s okay to get that.

For certain families, if they prefer to wait a little bit longer or are worried about a reaction, I wouldn’t say waiting any longer than 2-3 months.

It’s important to know that right now that children are carrying the burden of 25% of all new cases in our country so this is why this is the right time for kids to get the vaccine.

Dr. Messina: Even though COVID-19 is less serious in children it is still in the top 10 leading causes of death in children right now. COVID-19 in the adult population is vying for number one or two causes of death in the United States and for children it is still in the top 10, in fact for older children it’s in the top 5—so I think what people should understand is that children are a very healthy population so there shouldn’t be any deaths or hospitalizations. 

Can I just have my child take the first dose and not the second? 

Dr. Messina: The issue with just having one is you need that next dose to really stimulate what’s called the memory cells in your immune system. If you have it once, you will make antibodies, but what happens over time—and this happens with whatever vaccine—and remember, a lot of vaccines are given as a series –so that first dose of the vaccine helps your body make antibodies the second dose educates your memory cells to always make antibodies. So, you are not really done until you’ve had that second dose.  

What side-effects of the COVID vaccine are being seen in kids ages 5-11? 

Dr. Canody: In general children tend to respond very well to the vaccine and the rates of fever are much lower [and so are] rates of fatigue and malaise.

The overall side effects were a little bit of injection site pain or redness at the injection site, so unlike the adults where we really saw well over 50% have reactions, in children it’s much lower than that.

I don’t think you necessarily have to plan your schedule around getting the vaccine for kids, but maybe just understand for 24 hours not doing a lot of vigorous activity especially in the adolescents and older teenagers.

Speaking of side effects, we’ve heard of the rare instances of myocarditis– in teen boys specifically after the second dose. Is myocarditis something a parent should be concerned about with their younger children when they get the COVID vaccine?

Dr. Canody: At this point in the studies there were no cases of myocarditis in the younger children that were detected, however knowing that the 12–19-year-olds had the highest risk in adolescent males, put us to be cognisant of that. And it really occurs after the second dose not the first dose, so in the two weeks following the second dose, parents should be aware just look out for easy fatiguability, shortness of breath or not feeling well. But as I said, there were no cases of it in the preliminary studies.

There are several phases of the studies and once we start administering the vaccine, that is when phase four starts, so phase four is when we start collecting more information and we’ll know more details as time goes on.

Should I give my child a dose of pain relievers like Tyelonol or Motrin before their vaccination to mitigate any side effects? 

Dr. Messina: The recommendation is not to take it before the vaccine is given. If you don’t need to, don’t take it, especially Motrin type medications because they can actually blunt immune response a little bit, not completely, it’s not like it’s going to be worthless, but it will actually temper that immune response a little bit. 

What other concerns have you heard from parents about the COVID vaccine and their kids?

Dr. Canody: People are still really concerned about fertility issues and long-term consequences -as you know that has been brought up about several vaccines over the duration of my career a lot of people worried about that with the HPV vaccine-but I can tell you at this point in time, if anything the concern truly lies with post Covid infection. We have actually seen loss of pregnancies, premature deliveries, complications with related to covid during pregnancy, and there have actually been reports of decreased sperm counts, testicular enlargement, testicular inflammation after having COVID.

The one study that is being done through the NIH is reports on changes in females menstrual cycles after the vaccine. I don’t think this will affect the 5-11 year olds as much as the teenagers , but they are doing more research. But as a female you likely know that any kind of stress can change the timing of your cycle so they’re not sure if it’s just the immune response or if it’s the stress of living through a pandemic.

There is nothing that has been linked to any kind of infertility or long-term problems with fertility in males or females.

Can kids get the COVID vaccine with other immunizations like the flu shot or other scheduled vaccines?

Dr. Canody: It is okay to do the vaccines at the same time. Based on the benefit vs risk, still being in the middle of a pandemic, it is still important to get kids caught up on their vaccines and it’s okay to do COVID along with that .

There have been plenty of rumblings of reaching herd immunity in Florida. Is the possibility of this a reason to not get the COVID vaccine since there are fewer cases now and many people have already either had it or are vaccinated?

Dr. Messina: I think this concept of herd immunity is a nice thought, but I don’t know how realistic that really is going to be –I think we’re in better shape than we used to be because cases are way down in Florida, which is great, but I don’t think we can be complacent and think it’s going to stay that way forever. 

Dr. Canody: Having the Delta variant doesn’t necessarily protect you against other variants and even for those at-risk populations, we know as long as our herd immunity—isn’t just based on having the virus and having the vaccine, herd immunity is truly based on having the vaccine itself.

We know that the biggest risk are the unvaccinated individuals in our state in our country and throughout the world.

In general, a vaccinated 50-year-old has the same risk of severe illness as an unvaccinated teenager. We know that’s how the immune system varies. So really getting the younger kids vaccinated and knowing that sad and difficult part of this is kids have had a big burden of disease. We saw unprecedented hospitalization rates throughout the summer and fall in teenagers and young children.

Not only that, they’ve had to deal with changes in social structure, deal with family members being sick or even having a family member die as a result of this pandemic. We still have to remember there are a lot of at-risk individuals in our community and society and even though the vaccine may help improve their risk from a severe illness, that still exists.

As long as the virus is being passed around from person to person and with a quarter of all new cases happening in children, truly that is where the large reservoir is.

This is where it’s not just doing what you do for yourself, but it’s also taking care of those around us, our family members, our community, and those at risk in our environment and being able to do the things we love to do so much.

Three years is your traditional pandemic cycle, we almost two years into this, but we feel like there is a light at the end of the tunnel.

And we really don’t know how future potential variants will impact kids? 

Dr. Canody: We do know the vaccine has shown effectiveness against multiple variants and recovering from one particular variant doesn’t necessarily mean you’re going to be immune to the next variant so we do feel that based on the data we have that the vaccine is superior in providing long term protection.

How will the free Pfizer COVID vaccine be distributed by BayCare throughout the Tampa Bay Area other than through a child’s pediatrician or pharmacy? 

Dr. Canody: St. Joseph’s Children’s Hospital and BayCare Kids will host vaccine clinics throughout the community. The vaccines will be administered in an in-office setting opposed to a drive-thru because children need to be observed for 15 minutes after the vaccine since it is under emergency use authorization, so with any new vaccination, it’s a 15 minute observation period.

A lot of parents are very anxious about it so we want to be able to reassure them, have a pediatric specific team to administer the vaccine, work with the families. People on the site who can help entertain as well and also people available for questions.

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