Question

What should parents know about the COVID vaccine for kids under 5?

Devika Bhushan, MD, FAAP

Answer

As the parent of an infant, I join so many of you in feeling a roller coaster of emotions—including sheer relief—now that COVID-19 vaccines for babies age 6 months through 4 years are recommended by the Centers for Disease Control and Prevention (CDC) and authorized by the Food and Drug Administration (FDA).

The American Academy of Pediatrics (AAP) recommends the COVID-19 vaccine for children in this age group. Soon enough, we’ll be able to protect our infants and youngest children with a vaccine—and ease the stress that has taken a toll on our mental health.

The wait is finally over

These past months, many of us have felt like we’re frozen in the year 2020, still living in the early months of the pandemic. As many as 18 million infants and children under age 5 had been ineligible for the vaccine until now —and those under age 2 years are too young to wear a mask.

We caregivers have had to work much harder to shield our children who are not yet protected from the virus—and manage anxiety, decision fatigue, and guilt in navigating a world that’s full of potential COVID-19 exposures. We find ourselves constantly trying to understand changing guidelines. We have made and remade plans—around sick or exposed close contacts, day care or school outbreaks and closures, and conflicts with work and other activities.

I also know the deep worry we experienced when our kids did get sick—most of all, the anxiety that if it’s COVID-19, maybe they’ll be one of the ones who get really sick from it. Add to that the stress of taking time off to tend to our children while figuring out when or where to test, how long to isolate, and who to notify.

What's happening with COVID-19 right now?

More than 13 million children under age 18 years have tested positive for COVID-19, including more than 5 million in 2022. Many home test results are not reported, and the real number is likely to be much higher. By February 2022, CDC reported that based on antibody testing, up to three-quarters of kids under age 18 had been infected.

By the end of May, highly contagious omicron subvariants were causing nearly all of the new COVID infections in the United States, according to the CDC.

Since the beginning of the pandemic,more than 2 million children younger than 5 have been infected with COVID-19, and more than 400 young children have died from COVID-19. We have also seen that the impact of COVID on children has resulted in more infections, hospitalizations and deaths than from many other vaccine-preventable diseases, especially among children and families experiencing health disparities.

Unfortunately, many children do end up getting very sick, including with multi-system inflammatory syndrome in children (MIS-C). We currently have no way of predicting which kids will get this—the majority of cases occur in previously healthy kids. Over 8,000 kids have gotten MIS-C so far, and 68 have died from it. Also, some children will end up with long COVID⁠—which we're only just beginning to understand⁠—and other post-COVID-19 impacts like a higher risk for new-onset diabetes after recovery.

The good news is that vaccination in our littlest ones, just like for older kids and adults, is likely to prevent serious infection, complications, and death related to COVID-19. For example, in one study, two doses of the Pfizer vaccine reduced MIS-C by 91% in youth 12 to 18 years of age.

What should parents know about COVID vaccine safety for kids under 5?

The FDA has conducted a very careful and thorough review of the safety and effectiveness vaccine data for children under age 5—and I'm confident that the FDA authorization means we can be sure that either vaccine will do its job, safely and effectively.

The vaccines for our littlest ones are comprised of much smaller doses than the adult vaccines—Moderna’s is two doses (each a quarter of the adult dose) one month apart for kids 6 months to 5 years and Pfizer’s is three doses (each a tenth of the adult dose) over 11 weeks for kids 6 months to 4 years. Both vaccine regimens showed similar antibody response in kids as the adult studies. No significant safety concerns were raised in the trials—and we also now know that millions of children over age 5 have safely received a COVID-19 vaccine.

The bottom line: I have confidence in these vaccines’ ability to significantly and safely reduce the risk of serious harm from COVID-19 for our littlest ones—and that’s why I’m planning to get my son vaccinated as soon as possible, with either regimen that’s available.

What else can parents do to protect kids under 5?

Millions of children and teens have been vaccinated. Many still need to get immunized. Children will have highest degree of protection two weeks after they get the last required dose. There are some steps we can keep following:

• Continue to mask indoors with a high-quality and well-fitted mask like an N-95 or KN-94, or use a double mask (cloth over medical mask), for those 2 years and over. While children under 2 are too young to be masked, one tip is to use the rain cover on a stroller to give them an added layer of protection when they're in public.

• Cocoon our little ones by making sure everyone around them who can be is vaccinated, and their siblings 5 years and older are boosted.

• Keep gatherings small and ideally only with other households who are boosted. Consider taking rapid tests before gathering.

• When possible, travel by road instead of by plane or train to minimize contact with others who could be carrying the virus, especially those whose vaccination status is unknown.

• Minimize contact with large groups indoors, like at restaurants.

• See friends and family outdoors when possible. If indoors, make use of good ventilation—open windows, use filters and window fans.

I'm eager to have my little one vaccinated, and I know you are, too. Hang in there—we're almost there in getting our littlest ones the fullest protection we have.

Being a parent right now is one of the hardest jobs around. In these incredibly challenging times, remember to take care of and be kind to yourselves. Affirm that you're doing the best you can under these exceptional circumstances. I'm sending all of you fellow parents love and solidarity.

Devika Bhushan, MD, FAAP, is an equity-focused pediatrician and public health practitioner who serves as California’s Acting Surgeon General, focusing on three priorities: childhood adversity and toxic stress, early childhood development, and health equity. Follow her on Twitter @DrDevikaB.

Last Updated

6/22/2022

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.