We've reached another major milestone in the fight against COVID-19. On November 2, the Pfizer vaccine was approved for emergency use in children ages 5 to 11 years old. The authorization follows recommendations from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). That means most high schoolers, middle schoolers, and elementary school students can get vaccinated against COVID-19 now (those ages 12 and up got the go-ahead for vaccination back in May).

Kids ages 5 to 11 will get a smaller dose of Pfizer—two doses of 10 micrograms each, which is one-third of the adolescent and adult dose. It will be given as two shots, spaced three weeks apart, and it's 90.7 percent effective in preventing COVID-19, according to an October 29 press release by the FDA. While distribution can begin immediately, pediatric vaccine roll-out should be fully operational by the beginning of next week.

Naturally, parents have questions about this major vaccine breakthrough. We spoke with Marcella Nunez-Smith, M.D., a co-chair of President Biden's COVID-19 Health Equity Task Force, to learn more.

Children with face mask back at school after covid-19 quarantine and lockdown.

Children generally have mild cases of COVID-19. Why is it important for them to get vaccinated? 

While COVID-19 is usually mild in children, serious illness and death have been reported. According to the American Academy of Pediatrics (AAP), children represent 16.6 percent of all COVID-19 cases in America. About 0.1 to 2 percent of pediatric cases result in hospitalization, based on data reported by some states, and up to 0.03 percent of cases are fatal. "We've lost over 700 children to COVID-19," says Dr. Nunez-Smith. 

Vaccination can also prevent long-term effects of COVID-19—such as joint pain, fatigue, and difficulty concentrating—that can last for weeks or months after infection. Long COVID can even happen after mild or asymptomatic cases of the coronavirus. 

"And, of course, there's MIS-C, which is something we have seen uniquely among children," says Dr. Nunez-Smith. Multisystem inflammatory syndrome in children (MIS-C) is a serious condition that happens rarely after COVID-19 infection, and it can cause inflammation the heart, organs, lungs, kidneys, brain, and other body parts, says the CDC. MIS-C can be serious or deadly in young people. 

Finally, vaccinating kids can protect other members of their household, including the elderly or immunocompromised, who tend to get more severe cases of COVID-19. "As a parent, there are many, many reasons to get our children vaccinated in that younger age group to protect them," says Dr. Nunez-Smith. "And that's in addition to the benefits to our families and communities of having everyone vaccinated."

Where can children ages 5 to 11 get vaccinated? 

According to Dr. Nunez-Smith, pediatric vaccines will be available at more than 20,000 locations across the country, including pediatrician's offices, children's hospitals, community health centers, schools, and local pharmacies. If you're looking for a provider, Dr. Nunez-Smith recommends visiting the Vaccines.gov website. "Vaccines.gov remains a critical resource for anyone trying to get connected with vaccines, including our younger children," she says.

Kids ages 5 to 11 will get a smaller dose of Pfizer—about one-third of the dose given to adolescents and adults. What’s the reason for this?

"Children are not little adults," says Dr. Nunez-Smith. "It's critical to set up clinical trials specific for children" to make sure we have the science right. The FDA, CDC, and medical adviser have rigorously pored over clinical trial results to determine the lower dose is safe and effective for younger children. It's been shown to have over a 90 percent efficiency, says Dr. Nunez-Smith.

What are the COVID-19 vaccine side effects in children? Do they differ from adult side effects? 

Overall, pediatric side effects are similar to those experienced by adolescents and adults. "The number one side effect has been a sore arm," says Dr. Nunez-Smith, adding that fever, chills, and fatigue are also common. Tiredness, headache, and nausea have been reported as well, according to the CDC. 

"I always tell folks to stay hydrated right before and after the vaccination," says Dr. Nunez-Smith. "And if anyone gets a fever or chills, it's absolutely fine to take a fever-reducing medication." (Note, however, that you shouldn't take medication before getting the vaccine; the CDC only recommends it afterward if you have symptoms). 

Some parents have been put off by rare reports of myocarditis and pericarditis (inflammation of the heart) after vaccination—usually in male adolescents and young adults after the second dose. But this potential side effect is "extraordinarily rare," says Dr. Nunez-Smith. "Among the children in the vaccine trials, we didn't see any cases at all." Plus, she adds that children have a greater risk of heart inflammation after COVID-19 infection than vaccination—and it tends to be more severe with the coronavirus. 

Some parents are hesitant to get their kids vaccinated, citing fear of long-term side effects. How can we be sure the COVID-19 vaccines are safe? 

So far, "the pediatric vaccination is closely following the way the vaccines are performing in those who are older," says Dr. Nunez-Smith. Experts have been impressed by the safety profile and effectiveness, and there have been no red flags. Indeed, according to a press release by the FDA, "The vaccine's safety was studied in approximately 3,100 children age 5 through 11 who received the vaccine and no serious side effects have been detected in the ongoing study." 

Also, parents should consider the alternative to vaccination: possible infection with the coronavirus. "Very sadly, we're seeing that there are long-term effects, and some serious short-term effects too," says Dr. Nunez-Smith. The risk of COVID-19 infection continues to vastly outweigh the extremely minimal risks of vaccination.

If your child recently received the flu shot or another vaccine, do they need to wait for the COVID-19 vaccine?

According to the CDC, you can get the COVID-19 vaccine and other vaccines—including the flu shot—at the same time. "For many parents, it might be a preferred option to have a one-time vaccination," says Dr. Nunez-Smith.    

Will kids need COVID-19 vaccine booster shots in the future?

"This question is actively being investigated in the folks who have participated in the trials," says Dr. Nunez-Smith. In other words, experts don't know yet, but they'll thoroughly evaluate data to make a decision in the future.

Should children get vaccinated if they already had COVID-19?

Experts still don't know much about immunity acquired by COVID-19 infection. How long does it last, and how strong is it? Because of this, "the clinical recommendation is for everybody, pediatric and adult, who has had a confirmed case of COVID-19, to still get vaccinated. You can absolutely talk with your pediatrician about the timing," says Dr. Nunez-Smith.

When might children younger than 5 be eligible for the vaccine?

Pfizer is currently conducting clinical trials for children 6 months to 5 years old. "There's no crystal balls, of course," says Dr. Nunez-Smith. "But the timelines now suggest that we'll have clinical trial data available for review at the beginning of calendar year 2022." Assuming all goes well, emergency use authorization for children under 5 might come soon after that.

What should kids do after receiving the COVID-19 vaccine? Do they still need to take precautions, such as wearing masks and social distancing?

Vaccine approval for kids ages 5 to 11 is a major step toward ending the pandemic. That said, COVID-19 is still spreading, which means masking and social distancing remain important for keeping our communities safe. "These numbers are still real. I don't think we're in a place to say we're going to pull down public health mitigation," Dr. Nunez-Smith. She recommends staying informed with transmission levels in your community, and following all recommended health protocols.

The Bottom Line 

"Everyone in the [Biden] administration has been working really hard on making sure it's going to be easy, convenient, and free to get our children vaccinated," says Dr. Nunez-Smith. "We have supply for every child in this country." Getting vaccinated when it's your turn can help slow the spread of COVID-19, keeping families safe and helping America get one step closer to finally ending the pandemic.


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