What to know before vaccinating your 5-to-11-year-old with Pfizer’s COVID vaccine

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Nearly 1 million kids under 12 will have gotten their first shot before the end of the day, according to White House officials.

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The COVID-19 vaccine program for kids ages 5 to 11 is in full swing this week, with many pharmacies, pediatrician’s offices, public health centers and clinics administrating the coronavirus vaccine to kids under 12. According to Jeff Zients, White House COVID-19 response team coordinator, more than 900,000 children in that age group will have gotten their first shot by the end of day on Wednesday.

The US Centers for Disease Control and Prevention recommended Pfizer’s COVID-19 vaccine for kids ages 5 to 11 last week, a moment many parents have been waiting for. Now, children 4 years and younger are the only people not eligible for a COVID-19 shot.

Pfizer’s vaccine for kids is one-third of a regular dose, a slightly different formula and given with a smaller needle. It was authorized by the US Food and Drug Administration last week after data showing an encouraging safety profile and high effectiveness (90.7%) was reviewed by an independent committee for the FDA. In an ongoing trial that tested the vaccine in about 3,100 children ages 5 to 11, no serious side effects were reported.

“We know millions of parents are eager to get their children vaccinated, and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine,” CDC director Dr. Rochelle Walensky said in a statement. “As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated.”

With green lights from both the CDC and FDA, parents are now able to take their children in for a COVID-19 shot. Here’s what to expect when your child gets vaccinated against the coronavirus.

Do young kids even need a COVID vaccine?

Children remain at low risk of severe COVID-19 disease and death compared with the adult population. (Of states that reported data to the American Academy of Pediatrics, 0.1% to 2% of COVID-19 cases in children resulted in hospitalization.) But children can experience complications from COVID-19, including long COVID and multisystem inflammatory syndrome.

Kids ages 5 to 11 are also at least as likely to be infected with COVID-19 as adults are, according to data shared at a meeting of FDA advisers — more than 1.9 million children in that age group have been infected since the beginning of the pandemic. According to CDC data from Nov. 9, 189 children ages 5 to 11 have died from COVID-19 in the US.

There are also racial disparities in how sick children get from COVID-19. Children ages 5 to 11 who are Black, Native American or Hispanic are three times more likely to be hospitalized with COVID-19 than white children, according to the presentation. Of children ages 5 to 11 hospitalized with COVID-19, about one in three will require an ICU admission.

The pandemic has had other effects on children, including mental and emotional tolls. In mid-October, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency in child and adolescent mental health, with children from communities of color being disproportionately affected. Given the role that in-person learning plays in a child’s development, the CDC prioritized in-person learning for students this fall, and it has guidance on prevention strategies schools should use to keep students and staff safe.

When will kids be able to get a COVID-19 vaccine?

Now that both the FDA and CDC have signed off on COVID-19 shots for kids ages 5 to 11, children in that age group can get vaccinated. It may have taken a few days for your local pharmacy or health clinic to get Pfizer’s vaccine for kids in stock, however, because it’s different from Pfizer’s vaccine for everyone else (more on that below). However, this week was the deadline from the White House to have the program “fully up and running,” so the vaccine should be widely available to kids ages 5 to 11 right now.

Kids age 12 and up have been eligible for Pfizer’s COVID-19 vaccine for a while. The other mRNA vaccine, Moderna, and the only single-dose vaccine on the US market, Johnson & Johnson, aren’t available to kids yet.

Where should I go to get my child vaccinated?

The COVID-19 vaccine for kids under 12 will be free, just like it is for adults, and will be available in pediatrician’ss offices, doctor’s offices, public health clinics and places accessible to children. (Mass vaccination sites that provided COVID-19 shots to adults will not be used as part of the child vaccine program.) A good place to start would be calling your pediatrician or local health clinic for a recommendation on where to go.

Parents may also use this vaccine-finder link to find a clinic that has the child vaccine available.

How is Pfizer’s vaccine for young kids different?

Pfizer’s vaccine is one-third the dose of the vaccine given to everyone age 12 and older (but it’s still given in two shots, three weeks apart). The needle used to administer the vaccine will also be smaller. Additionally, the cap on the vial the vaccine comes in will be orange instead of purple and gray to avoid mix-ups.

The formula of the vaccine also varies slightly from the formula for adults. Pfizer’s vaccine for kids can be stored up to 10 weeks in a fridge, making it easier to administer. For more information about Pfizer’s vaccine for younger children, check out this fact sheet by the FDA.

Should I worry about myocarditis?

Myocarditis and pericarditis, or inflammation of the heart muscle, is an uncommon side effect linked to the Moderna and Pfizer vaccines and is mostly seen in adolescent males and men under 30. After looking at data and weighing the risks of vaccination and benefits of protection from COVID-19, the CDC still recommends everyone, including children as young as 5, get vaccinated.

Prior to the CDC’s official recommendation, experts that give guidance to the agency and vote on whether to recommend vaccines discussed the risks versus benefits for children as young as 5 years old. Although they do not have data to show the absolute risk of myocarditis for kids ages 5 to 11 (drug trials of all kinds may not always pick up on rare side effects, because it sometimes takes hundreds of thousands of people for one to show up), experts noted that baseline myocarditis is much lower in kids ages 5 to 11 than other groups. By contrast, they have a much higher risk of MIS-C, a potentially serious complication of COVID-19.

“The bottom line is that getting COVID is much riskier to the heart than anything in this vaccine, no matter what age or sex you have,” Dr. Matthew Oster said after a presentation on myocarditis prior to the CDC’s recommendation.

Side effects in kids ages 5 to 11 were mostly mild and similar to the side effects adults may experience after vaccination, according to the CDC.

Do I need to give consent in order for my young child to get vaccinated?

Yes, parents generally need to consent to their children receiving medical care, which will include Pfizer’s COVID-19 vaccine. This is especially true for younger children.

However, if you have a teenager or child old enough to express a desire to get a COVID-19 vaccine and you haven’t given consent, they may have legal precedent to seek one out, depending on which state you live in.

In Tennessee, the rights of minors versus their parents when it comes to vaccine decisions came under the spotlight last summer when the state’s vaccine director, Michelle Fiscus, was allegedly fired, in part, for sending out a memo explaining Tennessee’s “mature minor doctrine,” which is the state’s writing on how minors may seek medical care without the consent of their parents in some cases.

If my child is immunocompromised or has a health condition, can they get a third shot?

A third dose of Pfizer’s vaccine isn’t authorized or recommended for immunocompromised children ages 5 to 11. Additionally, the boosters currently available to some Americans who received ModernaPfizer or Johnson & Johnson are only for adults age 18 or older. No minor is eligible for a booster.

If your child is at least 12 years old, “moderately or severely” immunocompromised and vaccinated with Pfizer, according to the CDC, they should get a third dose of Pfizer. Moderna is only authorized for people age 18 and older. Examples of people who are immunocompromised include people receiving treatment for cancers in the blood or tumors, organ transplant recipients, stem cell transplant recipients, people with untreated or advanced HIV infection and people taking drugs that could suppress the immune response, per the CDC.

Does Pfizer’s full FDA approval extend to kids?

The FDA’s approval of the vaccine by Pfizer and its partner, BioNTech, only applies to people as young as 16 years old. While Pfizer remains the only vaccine authorized for use in kids as young as 5 years old, vaccinating that age group is still under emergency use authorization rather than total approval. This is because, along with other factors, full FDA approval requires data on how the vaccine fares six months out, per NPR. Pfizer’s vaccine was only authorized for kids age 12 to 15 in May.

This means that a vaccine mandate that hinges on full approval of a coronavirus vaccine, such as the one announced for school kids in California, won’t apply to kids younger than 16 for a while.

My child has allergies. Can they get the vaccine?

“If the child has a history of anaphylaxis or other severe allergies, then the observation time after the injection may be 30 minutes instead of 15,” Dr. Anne Liu, an infectious disease specialist with Stanford Hospital and Clinics and the Lucile Packard Children’s Hospital, said in August. So you might be asked to stick around the waiting room with your child for an extra 15 minutes so health care providers can monitor vaccine recipients for the (extremely rare) allergic reaction that can occur after any vaccination.

Additionally, Liu said, children who are prescribed an EpiPen for any reason should bring it to their vaccine appointment.

As for adults, children with an allergy to an ingredient in Pfizer’s COVID-19 shouldn’t take it. Find a list of ingredients in Pfizer’s vaccine for kids ages 5 to 11 on the FDA’s fact sheet.

Can my child get the COVID-19 shot at the same time as other vaccines?

Yes, according to the CDC, your child may get other vaccines when they go in for their coronavirus shot without waiting 14 days between appointments. Flu shots can be given to children age 6 months and older.

Correction, Oct. 25: A previous version of this story included a sentence implying incorrect information about available vaccines for children age 12 and older. Only Pfizer’s vaccine is currently available for kids ages 12 to 17.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.