Since the Food and Drug Administration (FDA) gave the green light to the COVID-19 vaccine for babies, toddlers and preschoolers, many parents of the youngest children have opted to vaccinate their little ones. Others, however, have held off, citing concerns about the shots' safety.
But doctors and other experts say it's incredibly important to vaccinate your little one against COVID-19, and assure hesitant parents that the shots available are perfectly safe and effective with minimal-to-no side effects.
"Children under 5 [who have gotten sick with COVID-19] have had a higher risk of death and hospitalization than children ages 5 to 11," says Gina Posner, M.D., F.A.A.P., a pediatrician at MemorialCare Medical Group in Fountain Valley, California and member of the What to Expect Medical Review Board. "The vaccine seems to be very protective over getting very ill from COVID."
In June 2022, the FDA authorized emergency use of both the Pfizer-BioNTech COVID-19 vaccine (for children 6 months to 4 years old) and the Moderna vaccine (for children 6 months to 5 years old). A panel of advisers to the Centers for Disease Control and Prevention (CDC) unanimously voted to recommend them, and CDC director Dr. Rochelle Walensky endorsed the recommendation.
Since then, about 2 million U.S. children ages 6 months to 4 years old, or about 12 percent of that age group, have received at least one dose of this critically important vaccine, according to the American Academy of Pediatrics (AAP), citing the CDC's March 1, 2023 statistics.[1]
Here’s a look at everything we know about the COVID-19 vaccines for young children, plus why it’s so important for eligible kids of all ages to be vaccinated against the virus.
Can babies and children get the COVID-19 vaccine?
Yes. Currently, the Pfizer-BioNTech vaccine has full approval from the FDA for those 16 and older and is authorized for emergency use in those 6 months and up. The Moderna vaccine (marketed as Spikevax) has full FDA approval for people 18 and up and is authorized for emergency use in those 6 months and up.
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How long should my child wait between doses of the COVID-19 vaccine?
Babies and toddlers can get either vaccine (Moderna or Pfizer-BioNTech), depending on availability in their area and their families' preference, the CDC says. Dosing schedules for children ages 6 months through 4 years will differ based on the type of vaccine your child receives.
The dosing schedule for children for the Pfizer-BioNTech and Moderna vaccines is as follows:
- The Pfizer-BioNTech vaccine: Young children 6 months to 4 years should get a second dose three weeks after the first, and a third dose at least eight weeks after the second. Children 5 and up should get the second dose of the Pfizer-BioNTech vaccine three weeks after the first dose and a booster (with either the Pfizer or the Moderna mRNA shot) at least five months after the second dose.
- The Moderna vaccine: Children between 6 months to 17 years should get a second dose four weeks after the first. They can also get a booster (either the Pfizer or Moderna mRNA shot) at least five months after their second dose.
In September 2022, the CDC echoed previous statements it had made that COVID-19 vaccines may become annual like flu shots. Talk to your pediatrician if you have any questions about the spacing between vaccine doses.
Can my child get the COVID-19 shot at the same time as another vaccine?
It’s perfectly fine for your child to get the COVID-19 vaccine at the same time as another routine vaccine (or shortly before or after), including the flu shot, the CDC says. There are no increased risks of side effects from getting the COVID vaccine along with another vaccine.
Should children get the vaccine if they already had COVID-19?
The CDC stresses that everyone eligible for the vaccine should get it, even if they already had COVID-19. Right now, that includes adults (including pregnant women) and all children 6 months and older.
It’s true that the body gains some protection from COVID-19 after infection. But experts don’t know for sure how long that protection actually lasts. Getting the vaccine typically leads to a more consistent antibody response, the CDC says.
Talk to your pediatrician about how long to wait between a case of COVID-19 in your child and the vaccine, if your little one was unvaccinated or partially vaccinated at the time of infection with the virus.
Does my child need a COVID-19 booster shot?
Yes, it's a good idea to get your child a COVID-19 booster if they're eligible. Right now, everyone ages 6 months and older can get at least one of the available booster shots after receiving their primary COVID-19 vaccine series. Certain groups can also receive a second booster shot.
A booster helps enhance or restore the protection against COVID-19 that the vaccine offers. That's why the CDC recommended the original booster shot for kids ages 5 to 11 who've completed a primary vaccine series more than five months ago. In one study, Pfizer and BioNTech found that a booster shot on top of the original two doses of the vaccine upped antibody levels 36 times against the Omicron variant compared with getting just the initial two doses of the vaccine.
Updated COVID boosters that specifically target the aggressive and long-dominant BA.4 and BA.5 Omicron subvariants have been available since September 2022. Together, all the Omicron variants have accounted for the majority of U.S. COVID-19 cases during much of 2022. [2]
The updated, multi-strain Omicron boosters were authorized for emergency use by the FDA, got the green light from the CDC and began rolling out in the fall of 2022.[3] The current bivalent vaccines contain two mRNA components of COVID-19, one based on the original strain of the virus and the other one targeting BA.4 and BA.5.
As of December 2022, children as young as 6 months old became eligible for both the Pfizer and Moderna updated boosters,[4] which are also available to kids 5 and older and adults. Experts say that like the original vaccines, the newest boosters have been safe and effective at preventing serious illness, hospitalization and death, and offer good protection against the strains they target.
Those who want these one-dose, Omicron-specific boosters can get them at least two months after primary or regular booster vaccination. In March 2023, the FDA authorized for emergency use the Pfizer bivalent booster as a fourth shot for babies and toddlers 6 months through 4 years of age who have completed their three-dose primary vaccination series. The previous December 2022 authorization by the FDA allowed children in that age group to get the bivalent booster as their third and final dose if they were only partway through their vaccinations.
Are the COVID-19 vaccines safe for infants and young children?
Yes. As with all vaccines, the COVID-19 vaccine has gone through a meticulous research and approval process to ensure its safety for both adults and children. In fact, the CDC says the COVID-19 vaccines have had "the most intense safety monitoring in U.S. history."
In a June 2022 news release, the AAP said in a statement that the group "supports [the CDC's] recommendation and encourages pediatricians to promote vaccination and give COVID-19 vaccines."
Data from clinical trials shows that the Pfizer-BioNTech vaccine is safe and effective at preventing symptomatic COVID-19 in children under 5 (as well as in those 5 and older). Clinical trials looking at the safety and efficacy of the Moderna vaccine in children have also yielded positive results.
"The AAP has pushed for rigorous studies in children so we know the vaccine is safe, effective and the right dose," says Jen Trachtenberg, M.D., assistant clinical professor of pediatrics at Icahn School of Medicine at Mount Sinai in New York City and spokesperson for the AAP.
There's also no need to worry that the mRNA technology used in the Pfizer-BioNTech and Moderna vaccines will change your child’s DNA. mRNA is unable to enter the nucleus of the cell, where our DNA lives, plus, the mRNA is broken down by the body shortly after a person is vaccinated, according to the CDC.
Why weren't children included in the first COVID-19 clinical trials?
Children's immune systems are different from those of adults, and their immune responses can vary according to their age, explains Sean O'Leary, M.D., M.P.H., vice chair of the Committee for Infectious Diseases at the AAP and professor of pediatric infectious diseases at the University of Colorado Anschutz Medical Campus/Children’s Hospital Colorado.
While a teenager may respond to a vaccine similarly as an adult, an elementary school-age child, a toddler or an infant could have a different reaction. That’s why it's so important to hold clinical trials in kids separately.
The trials in children go through two stages. The first stage looks at different dose levels, explains Rajeev Fernando, M.D., an infectious disease expert and member of the What to Expect Medical Review Board. As a next step, those doses are then tested against placebo injections.
About 24 percent of the U.S. population — around 74 million people — is under 18, and experts say getting kids vaccinated is important to prevent severe illness and hospitalization.
Does the COVID-19 vaccine cause myocarditis in children?
There were no reports of myocarditis — an inflammation of the heart muscle — from either vaccine in the clinical trials for children ages 5 to 11 or in the clinical trials for children under 5. A very small number of adolescents and young adults have experienced mild cases of myocarditis after receiving the COVID-19 vaccine. That said, becoming infected with COVID-19 is much more likely to cause myocarditis than receiving the vaccine, according to the AAP.
Myocarditis can occur when the body’s immune system reacts to an infection or another trigger. Symptoms of myocarditis include:
- Abnormal heart rhythms (feelings of a fast-beating, fluttering or pounding heart)
- Shortness of breath
- Chest pain
Post-vaccine cases of myocarditis and pericarditis — an inflammation of the outer lining of the heart — have occurred most often in males, after the second dose and within a week of inoculation. Most patients recovered quickly with rest.
Can the COVID-19 vaccine give my child the virus?
No. The COVID-19 vaccine works much like other routine immunizations that children receive. It contains molecules with a set of instructions that teach the immune system to make its own protective antibodies that can fight the germs that cause the virus, says the AAP.
But the vaccines don’t contain the actual virus itself. "There’s a zero chance of someone getting COVID-19 from the COVID-19 vaccine," Dr. Fernando says.
If a child (or adult) feels a little under the weather after being vaccinated, that doesn’t mean they have COVID-19. Instead, they’re experiencing normal side effects that can develop as the immune system kicks into high gear to launch a protective response against the virus, the CDC notes.
What side effects might a baby or young child experience after COVID-19 vaccination?
Side effects for both the Pfizer-BioNTech and Moderna shots have been shown to be similar to the types of mild, short-lived side effects your infant, toddler or young child might experience from other immunizations. Fever and soreness at the injection site were most common; babies and toddlers under 3 years may also be sleepy, irritable or have less of an appetite, while children 3 to 5 years might feel low energy, have a headache or experience flu-like symptoms.
These side effects can be a little inconvenient — crabby babies and toddlers aren't fun. But experts agree that protection against COVID-19 is worth a day or two of discomfort.
"The problem with COVID is that we just don't know who will get really sick and who will not get sick at all," Dr. Posner says. "I would prefer my child get mild side effects from a vaccine and hopefully get decent protection from severe illness versus taking the chance."
Wondering about the shots' impact on bigger kids? As with adults, the most common side effects in adolescents and older children are a sore arm, fatigue, headache, chills, fever and muscle and joint pain, particularly after the second dose, the FDA notes. Side effects don’t seem to be stronger or more prevalent in kids, and many haven’t had side effects at all.
As with other vaccines, it’s possible for a child or adult to experience an allergic reaction to the COVID-19 shot. These reactions are extremely rare, but when they do occur, it's usually shortly after immunization. That’s why everyone who gets the vaccine needs to wait 15 to 30 minutes before leaving the facility where they received the shot. If an allergic reaction happens, medication can quickly treat it.
As for longer-term side effects? In general, monitoring of other vaccines shows that side effects tend to occur within six weeks of being immunized, and the CDC expects the same to be true for the COVID-19 vaccine. If parents have any concerns after their children receive the vaccine, they should check in with their pediatricians.
Are the COVID-19 vaccines effective in infants and young children?
Yes. Pfizer says its vaccine is 80 percent effective at preventing COVID-19 infection in children 6 months to 4 years of age. Moderna’s vaccine efficacy was 51 percent in clinical trials for those 6 months to under 2 years and 37 percent for children ages 2 to 5.
The Pfizer-BioNTech COVID-19 vaccine is also effective at preventing severe illness in kids as young as 5. One study published in the New England Journal of Medicine found that kids ages 5 to 11 who had received two shots of the vaccine were 68 percent less likely to be hospitalized during the Omicron surge than their unvaccinated peers.
Vaccinated adolescents between the ages of 12 and 18 were also 40 percent less likely to be hospitalized with Omicron. And the risk of serious outcomes — like needing mechanical breathing assistance or even death — was slashed by 80 percent in this age group.
Another CDC report found that COVID-19 hospitalization rates in children ages 5 to 11 years were approximately twice as high among unvaccinated kids compared to vaccinated ones during the Omicron wave this past winter.
Another study published in the New England Journal of Medicine in May also found that two doses of the Moderna vaccine produced a strong immune response in the 6- to 11-year-old age group.
Why is it so important for children to get the COVID-19 vaccine?
First and foremost, it’ll protect your child’s health. "The vaccine is the best way of not getting COVID-19," says Dr. Trachtenberg. Vaccines also reduce the chance of serious illness and/or hospitalization for children who do contract the virus, Dr. Posner adds.
It’s true that kids are less likely to get seriously sick compared to adults. But they can still contract the virus and spread it to others, even if they don’t show COVID-19 symptoms.
Millions of children have contracted the virus since the start of the pandemic. In rare instances, kids can develop severe complications that require hospitalization, intensive care or a ventilator, the CDC notes.
And considering the pandemic's effects on their daily lives, vaccination offers more than just physical protection.
"We’ve seen the toll this has taken on kids' mental health," Dr. Trachtenberg says. "We really want children and adolescents to return to normal as much as possible, to be able to do their activities, socialize with friends indoors and feel confident at school."
Vaccinating your child also protects others in the community who may not be able to get immunized, says Dr. Fernando.
In short? "Vaccinations save lives," Dr. Fernando says.
Parents can currently get their little ones vaccinated at pediatrician offices, pharmacies, federally qualified health centers, local health departments, clinics and other locations around the country.
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