Covid Vaccine Kids Under 5: Parents' FAQs Answered

After the Centers for Disease Control and Prevention (CDC) officially approved both the Moderna Covid vaccine for kids under 6 and the Pfizer Covid vaccine for kids under 5 on Saturday, it felt like parents everywhere were finally able to exhale. The news comes one and a half years after vaccines were approved for adults—though for many parents, it feels like much longer. Now, shots could be in the littlest arms starting this week.

But the rollout is sure to give rise to lots of questions, especially for families whose children may already have contracted the virus. Others may also be wondering whether they should even vaccinate their child given their generally lower risk, while some will vaccinate but aren’t sure which shot to choose. While your child’s pediatrician should be your first point of contact, we’ve reached out to experts to get their opinion, too. Here’s what they told us.

Q. Should my child get the pediatric Covid vaccine?

When making your decision, it’s important to remember that little kids still make up a large portion of Covid cases. “More than 2 million children under 5 have had Covid since the start of the pandemic, and hospital visits increased for this age group during the Omicron wave,” pediatrician Mona Amin, DO, tells Motherly. According to the CDC, children under 5 had the highest rate of hospitalizations compared to other pediatric age groups during the Omicron surge.

This will be the first time that kids under 5 will be eligible for vaccination against the SARS-CoV-2 virus. Kids ages 6 months to under 5 years will be eligible for the Pfizer pediatric coronavirus vaccine, and kids ages 6 months to under 6 years will be eligible for Moderna’s.

No vaccine is likely to be developed for babies under 6 months of age, whose immune systems are too underdeveloped to handle the vaccination. (Though some studies show that vaccination in the third trimester of pregnancy and breastfeeding can help pass on antibodies to infants.)

But for kids older than 6 months, the benefits of vaccination far outweigh the risks, says Dr. Amin.

“It’s important to understand that this age group is at a lower risk for complications [from Covid infection] as we compare it to adults and even children over 5,” she notes. “That being said, when you look at the benefits of reducing hospitalization risk [from vaccination], it’s absolutely there.”

Covid, like the flu, is a vaccine-preventable illness, she adds. The vaccines are not 100% effective at preventing infection (no vaccine is), but they can help reduce the chance of your child getting a symptomatic infection, and they can drastically reduce a child’s risk of hospitalization or death—the vaccines are very, very good at this.

If you have family members who are immunocompromised, vaccinating young children can help to reduce their risk of severe disease, too.

Q. Should I choose Pfizer or Moderna for my under-5-year-old?

Both Pfizer and Moderna have developed mRNA vaccines for this age group are now authorized for emergency use by the FDA and approved by the CDC. If you’re wondering which vaccine your kids should get and whether there are benefits to choosing Pfizer vs Moderna, that’s the big question. While both vaccines are effective in terms of eliciting a strong immune response and were comparable to the immune response seen from the vaccines in older kids, there are some differences between the two.

Let’s break down the details:

More results can be seen in the FDA panel briefing docs here.

The salient points? Namely, Moderna reported 36.8% to 50.6% efficacy against symptomatic illness after two doses, whereas Pfizer reported only a weak response after the second dose. After a third dose of Pfizer, those numbers went up to 80.3%, however, experts consider that number to be unreliable because there were only three confirmed cases of Covid in this group, making that figure less precise. Despite the lack of confidence in Pfizer’s efficacy numbers, CDC panel experts unanimously voted to approve both vaccines, given that they both create a robust antibody response in kids under 5, at levels similar to those seen in young adults.

Moderna is currently testing a third dose in the pediatric group, for which results should be available this summer. It’s likely that Moderna will also be considered a three-dose series in the near future.

Both vaccines were tested during the Omicron wave, and show more limited effectiveness against Omicron than Delta, just as we’ve seen with adult vaccines.

As of now, there’s no official guidance from the CDC on which vaccine should be used in which circumstances. Your pediatrician is your best resource to help determine if there’s a better option for your child.

They’ll likely make that decision based on three factors, says Dr. Amin:

Has your child already had Covid?
Is there anyone in your family or in your close contacts who is immunocompromised, which may mean your child should be vaccinated sooner rather than later?
Does your child have any pre-existing medical conditions that could put them at risk for more serious Covid infection?

In some cases, it may come down to which vaccine is available to you first, and you really can’t go wrong.

But if you’re able to choose? It’s about weighing the pros and cons. The Pfizer shot seems to be better tolerated by most, but the 3-shot regimen means that reaching the level of being fully vaccinated is a months-long process.

“If you get the Pfizer vaccine, you have to remember that you’re not fully vaccinated to that 80% efficacy that they’re reporting until two weeks after the third dose. That’s a long period—and that’s why I’m recommending Pfizer more for children who are at low risk for complications, or if they’ve already had Covid,” notes Dr. Amin.

Because the Pfizer dose is much lower and the shots are so spread out, the side effects seen in the trial were more minimal.

The Moderna series is shorter, which means you’ll reach immunity faster, but side effects can be more moderate than mild. Moderna’s efficacy numbers are more reliable, too, and the vaccine shows protection against asymptomatic infection as well.

“If your child has never had Covid, or is at a higher risk for complications from Covid, you may want to lean toward Moderna to get faster, quicker immunity,” Dr. Amin notes. “But study participants who received the Moderna vaccine did report more pain at injection sites and more side effects, though it was short-lived.”

When asked to compare the vaccines at a press briefing after FDA authorization, Dr. Peter Marks, who heads up the FDA’s vaccine division, said that Moderna’s vaccine may trigger an immune response “slightly more rapidly,” while Pfizer’s might “bring a greater response after the third dose,” The New York Times reports. He said that parents should feel comfortable with either and opt for whichever one is available.

Q. What about if my child already had Covid? Should I still get them vaccinated?

Yes. Even though prior Covid infection does offer some natural immunity to prevent future infections, we still don’t know how long that lasts. “Per CDC recommendations, getting vaccinated adds protection,” says Suellen Hopfer, PhD, CGC, an assistant professor in the department of health, society and behavior, and the department of pediatrics at University of California, Irvine.

Data released in April suggests that 75% of kids and teens have some evidence of virus antibodies at this point in the pandemic. But that alone shouldn’t be interpreted as protection from future Covid infection, the CDC states in a report.

It’s key to remember that vaccination is especially helpful in preventing severe illness, hospitalization and death.

In adults, those who had a prior Covid infection and vaccination from an mRNA vaccine have now reached what experts are calling “super immunity” or “hybrid immunity.” They have a much stronger immune response than those who only had prior infection. We can likely expect the same for kids.

Q. Are the vaccines safe? What are the risks of the kids’ Covid vaccine?

Yes, the vaccines have an excellent safety profile. As seen in the table above, most kids who got Pfizer didn’t have side effects—or if they did, they were very mild. For those who got Moderna, reactions like pain at the injection site and fever were more common, but still mild to moderate.

There was very little evidence of serious adverse reactions to either vaccine, and no evidence of myocarditis or pericarditis were seen in either clinical trial, though trial sizes were limited to around 6,000 kids, and we’d need trial sizes much larger than that to see evidence of those conditions, because the risk is already so low.

“Myocarditis is a reality in natural Covid infection as well,” notes Dr. Amin. “The risk of getting it from the vaccine is much lower than getting it from the actual illness. I believe that the benefit does outweigh the risk of getting the vaccine when you understand that myocarditis happens generally in a population and with other viruses, as well.”

Q. Should I wait until fall to get my child vaccinated?

It depends on how soon you’d like them to reach immunity. Remember that the Pfizer vaccine’s first two shots are spaced out by three weeks each and then the third shot is eight weeks later, and then full vaccination doesn’t technically take effect until two weeks after that. That’s 16 weeks, or four months!

If you start the Pfizer vaccination series at the end of June, it’ll be the end of October by the time your child reaches full immunity.

Moderna is currently looking at creating a bivalent vaccine for adults which would make it more effective against the Omicron strains circulating now, but the company likely won’t have trial data on its effects in children until later this year. It would also need to go through the authorization process again.

Q. Will kids eventually need a booster?

Yes, there is a risk of the protective effects of the vaccines waning over time, says Dr. Hopfer, which means that boosters will likely be necessary at some point. “It is unknown how much time [it may take] for protective effects to wane,” she adds. “For this reason, layered protection, i.e., combining other protective strategies is important, such as having parents and older siblings vaccinated to prevent exposure in very young children.”

Masking for kids over 2 when in public places and social distancing when possible can also be effective in reducing the risk of infection.

Q. Is there any way I can reduce side effects from the shot?

It’s not recommended to give your child a pain reliever like Tylenol before getting vaccinated, but Dr. Hopfer recommends a morning vaccination appointment if possible.

“Getting your children vaccinated in the morning when cortisol levels are higher will offer the likelihood of your child’s body responding appropriately while minimizing the possibility of clinical side effects (not feeling well, fever, etc.) if that is something parents are worried about,” she notes. “It is not a guarantee, but scheduling to vaccinate in the morning (before or by 9 AM) may help mitigate.”

If your child has a reaction after the shot, talk to your doctor about giving Tylenol to reduce fever or injection site pain.

Q. How can I help my child be less scared of the shot?

Just as with other childhood vaccinations, breastfeeding your child during the shot administration or giving older kids something sweet to suck on, like a lollipop (the sugar and sucking action can reduce pain), may help make them feel better in the moment.

Preeti Parikh, MD, board certified pediatrician and executive medical director at GoodRx, shares these additional tips to help reduce fears:

1. Talk to your kid about what to expect when they go to the doctor’s office (like who will be giving them the shot and the process from beginning to end) and why the vaccine is important. Use words like “poke” or “pinch” that are less scary than “shot.”

2. Use a lidocaine/prilocaine numbing cream at least 30 minutes before the appointment and/or a vibrating ice pack to minimize sharp pain from the needle.

3. Bring your child’s favorite toy or blanket to help comfort them. Providing physical comfort to your child can also help soothe them while the vaccine is given.

4. Allow your child to watch videos on your mobile device, read them a book or tell a story to help keep their mind off the shot.

5. Before and after the vaccine is administered, have your child engage in deep and slow breathing exercises that can help calm their nerves.

WEB COVID 19 Vaccine Checklist for Parents Motherly — Courtesy of GoodRx

Q. Where can I get a Covid vaccine for my child?

Just like with vaccines for kids ages 5 to 11, vaccines for kids under 5 should be available at your pediatrician’s office. They may be running a special vaccine clinic, so call to see if you need an appointment or if they’re taking walk-ins on certain days. The Biden administration is also planning pop-up vaccine clinics at libraries and children’s museums.

For kids age 3 and up, vaccines may be available at your local pharmacy, but call to confirm first. Look to vaccines.gov for more information.