Ask the Pediatrician: COVID-19 vaccines for children under 5

This weekend, the CDC and FDA issued an emergency use authorization (EUA) for the Pfizer and Moderna COVID-19 vaccines for children 6 months to 5 years of age. This is big news for the more than 20 million kids in this country under the age of 5. For many of their parents, this news has been met with shouts of joy and tears of relief. For many others, however, this news has rustled up a whole host of questions and concerns, some they encountered before, when older children became eligible for the vaccine, and some they are encountering, perhaps, for the very first time.

As a pediatrician, I welcome parents’ questions – they are an important piece of what it means to be part of a child’s care team, and asking questions tells me that parents are interested, engaged and looking for trusted guidance. I’m honored to be a part of that trust, and in the spirit of welcoming questions, I wanted to share a few of the common questions I’ve received in my clinic about COVID-19 vaccines for children under 5 years of age.
 

My child under 5 doesn’t go to school or daycare, so do they even need to be vaccinated?

This is a good question, and I see where parents are coming from when they ask it. However, I like to start out by reminding them that kids live in families, so when we’re talking about COVID-19, we need to include the whole family in the conversation. Other family members could bring the COVID-19 virus into the home, so it’s important to ensure everyone is as protected as they can be. Plus, we want our little ones to experience all the fun that life has to offer outside of the house – we want them to visit the zoo, play with friends and do all the things that make growing up so special, all without having to worry about getting seriously ill with COVID-19.
 

But COVID-19 doesn’t really make kids that sick, right?

While most kids infected with the COVID-19 virus will recover, it’s important to understand that some become ill enough to need hospitalization and even intensive care. In rare instances, a child may die from COVID-19 infection or complications. There are also some potential post-COVID infection complications to consider, including a set of conditions known as “long-haul COVID” and Multisystem Inflammatory Syndrome in Children, or MIS-C. These complications can arise even if a child had an asymptomatic COVID-19 infection, meaning that they were infected with the virus but didn’t actually feel sick.
 

My child already had COVID-19. Do they even need to be vaccinated?

Regardless of a previous COVID-19 infection, getting vaccinated extends their protection against the virus, including against variants. Plus, getting vaccinated will help protect them against severe illness in case they are infected with COVID-19 again in the future, since naturally immunity is believed to only last for a brief period of time.
 

Is COVID-19 even around much anymore?

There is so much mixed messaging out there, it’s hard to keep everything straight! With the dropping of mask mandates, many people assume the pandemic must be over, or that it’s nothing to worry about anymore. Unfortunately, the truth is that COVID-19 is still very much here. And while getting vaccinated doesn’t guarantee that you won’t get infected with COVID-19, vaccines are effective at preventing severe illness and hospitalization. This is certainly something to consider in and of itself; the stress of having a parent or child hospitalized can have significant impacts on a family.
 

What are the side effects of this vaccine?

The minor side effects from these vaccines are similar to those seen with other childhood immunizations: redness, sore arm or a fever. All these are signs that your child’s immune system is responding and doing its job. Thankfully, these don’t occur often and are very temporary. It is important to know that in the thousands of children in vaccine trials, no serious side effects such as allergic reaction or heart inflammation were reported.
 

Does it matter which brand we get?

The best vaccine is the one that’s available! Both Pfizer and Moderna have been authorized for children and passed the standards for safety and efficacy. Regardless of which vaccine your child receives, it is important to know they are considered fully protected only once they receive all doses, so make sure to schedule the follow-up visits.
 

How do we prepare for our child’s vaccine appointment?

Children are often anxious for any sort of vaccine or immunization – even adults sometimes get a little nervous when they know there’s a poke involved! Before the appointment, talk with your child about why the vaccine is important and let them know you’ll be with them every step of the way. Give them an idea of where they’ll be going for their appointment and walk them through the process, from checking in to heading home. By knowing what to expect, children are often less anxious about the experience. Many families even like to make a fun event out of it! I’ve had families make themed shirts to wear all together to the appointment or celebrate with a special treat afterward. Be sure to bring some toys or other activities to help keep your child occupied during the 15-minute post-vaccination waiting period.

For families who come to Valley Children’s vaccine clinic, we’ve created a step-by-step picture guide (in English and Spanish) to help children and families prepare for their vaccine appointment.

As we cross this milestone in the fight against COVID-19, remember: pediatricians are in your child’s corner. Don’t be afraid to ask us questions! We’re here to help answer questions you may have about COVID-19 vaccines and ensure your child is up-to-date on well child visits and routine childhood immunizations. Plus, we’re not just pediatricians, many of us are parents, too, and we have the same goal: to help your child grow healthy, happy and thriving.

About the Author

Hailey Nelson, MD, FAAP, IBCLC is a complex care pediatrician at Valley Children’s Charlie Mitchell Children’s Center. Dr. Nelson enjoys working with children of all ages and abilities and is especially passionate about providing the best possible care to medically fragile children and their families. As the ambassador for Safe Kids Central California, she is a vocal advocate for children’s wellness and regularly appears in news media discussing pediatric healthcare.