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What pediatricians want parents to know about the Covid vaccine for kids

Pediatricians share the questions they’re getting and how they respond.
Grubbs Vaccinations
Zahari, 8, gets a Pfizer-BioNTech Covid-19 vaccine from pharmacist Elizabeth Alvarez at Grubbs Pharmacy in the Capitol Hill neighborhood of Washington, D.C., on Monday. Tom Williams / CQ-Roll Call, Inc via Getty Imag

As the Covid-19 vaccine has been rolling out for children ages 5 to 11, questions for pediatricians have been rolling in.

Many parents are simply wondering where they can find the long-awaited vaccine locally — and fast. Plenty other questions are from parents with a range of concerns about safety and effectiveness in kids.

Here are some common questions from parents, with advice from pediatricians around the country:

Is the vaccine safe?

Yes, it is safe for children 5 to 11, said Dr. Adriana Cadilla, a pediatric infectious disease specialist at Nemours Children’s Hospital in Orlando, Florida, and a mother of children ages 6 and 8 who were vaccinated Saturday.

Cadilla said she and most pediatricians are recommending the vaccine for their patients. “This is how we save lives,” she said. “We administer vaccines, we promote vaccines, and we would not recommend something that we wouldn’t do for our own child.”

In authorizing the two-dose Pfizer-BioNTech vaccine for emergency use in children ages 5 to 11 — the only Covid vaccine cleared for kids in the U.S. — the Food and Drug Administration said it was 90.7 percent effective in preventing symptomatic Covid, and there were no serious side effects in about 3,100 children studied who received it. The commonly reported side effects included arm pain, fatigue, headache, muscle aches, joint pain, chills, fever and nausea, and most effects went away within a couple days, the FDA said.

 “The side effects that you see with a vaccine are mild in comparison to if you did have acute Covid,” Cadilla said. “Vaccine is by far a safer choice.”

 Is there a risk of myocarditis from the vaccine?

As for concerns about heart inflammation known as myocarditis or pericarditis, no cases were reported in the Pfizer trial of children 5 to 11. The Centers for Disease Control and Prevention says there have been rare cases, mostly in male teens and young adults, and these patients can be treated with medicine and recover quickly.

The risk of heart inflammation from having Covid is actually a much bigger threat, said Dr. Gigi Chawla, chief of general pediatrics at Children’s Minnesota.

“Myocarditis is part of the illness that can be experienced by people with Covid-19,” she said. “The rates of people having myocarditis associated with illness versus vaccine are far greater for illness. So if a family truly is concerned about myocarditis, they should be vaccinated.”

Does the vaccine affect fertility?

“I don’t know that there’s any reason to believe that Covid vaccination would have any impact on fertility,” said Dr. Anna Sick-Samuels, an assistant professor of pediatrics at the Johns Hopkins Hospital, who has a 4-year-old she would vaccinate if she could.

“There’s no clear biologic link that the vaccine would even have,” she said. “There’s not a general reason that, or theory why, a vaccine of any kind should have impact on fertility.”

On the other hand, doctors do know that unvaccinated pregnant women can have potentially serious complications from Covid, Sick-Samuels said.

“We’ve seen that women who are pregnant and get Covid infection are actually more likely to have complications and preterm delivery and challenges, unfortunately, with their pregnancy and neonatal course,” she said. “And we know that the vaccine is really helpful in preventing those types of complications.”

Why is the vaccine based on a child's age?

Many parents are used to giving medication based on their child's weight. Why does a tiny 5-year-old get the same vaccine dose as a much bigger 11-year-old?

“Medicines work differently than vaccines,” explained Dr. Stanley Spinner, chief medical officer at Texas Children’s Hospital.

“If you give a full adult dose of [a drug] to a very small child, their liver or kidneys may not be able to manage that full dose,” he said. “But vaccines are inducing an immune response. So it doesn’t matter what your weight is. It’s really based on the immune response and that is more age-related.”

My child is turning 12 in a couple of months. Should I wait for the adult dose?

No, advises Spinner, because the Pfizer vaccine is just as effective at the 10 microgram dose for kids ages 5 to 11 as the 30 microgram dose is for older kids and adults.

“There’s no reason to wait to get the 30, you’re not going to get stronger protection waiting those few extra weeks with that higher dose,” he said. And delaying vaccinations means your child is unprotected longer.

For kids who turn 12 between the first and second doses, which are given three weeks apart, they will be given the adult dose the second time, Spinner said.

“It’s based on the birthday,” he said. “It’s not based on a weight or anything else.”

Why do kids need the vaccine if they don't get as sick as adults?

While children don’t die from Covid at the same rates as older people, they still can suffer short-term and long-term effects, develop multisystem inflammatory syndrome, require hospitalization, and spread the virus to others, said Dr. Ilan Shapiro, a spokesperson for the American Academy of Pediatrics and medical director of health education and wellness at AltaMed community health network in Los Angeles.

Vaccines protect against the “full heat of the Covid-19 disease,” which is why he plans to vaccinate his 6-year-old and 9-year-old. “For me, in knowing that my kids will be safer at school, that is the route that I am pursuing,” he said. “I want to protect my kiddos.”

There have been more than 1.9 million Covid cases in children ages 5 to 11 in the United States, according to the CDC. More than 8,300 children in this group have been hospitalized with Covid, a third of whom required intensive care, and 94 have died, CDC data show.

Vaccinating children not only protects them, but it also helps protect the community and hopefully can help restore some normalcy, said Dr. Jay Harvey, a pediatrician in private practice in Boca Raton, Florida.

“The overhead view is that the more children and adults who are vaccinated, the quicker everyone gets out of the pandemic, we stop the spread, we prevent the creation of new mutant strains, or at least limit that,” he said, “and everybody gets to hopefully start living the life they left behind almost two years ago.”