The COVID-19 Vaccine and Kids: What Parents Need to Know

The COVID-19 vaccine is readily available across the country. Everyone age 6 months and older is eligible to get vaccinated, and in most cases, boosted.

Parents had to wait quite a while for their children to be eligible for vaccination, and it felt like forever. The vaccine was first approved for adults in December 2020—about nine months into the pandemic. It then took about a year and a half for the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to approve the vaccine for children.

But in February 2022, the CDC took the step of adding the COVID vaccine to its recommended childhood immunization schedule. This is the schedule health care providers use to keep your children healthy. Some immunizations may be mandated for children to attend school, but that varies from state to state. Adding the COVID vaccine to the immunization schedule does not mean it is mandated, but rather recommended.

Available COVID-19 Vaccines

There are currently three COVID vaccines approved by the FDA in the United States: Pfizer-BioNTech (now marketed as Comirnaty), Moderna (now marketed as Spikevax), and Novavax. As of May 2023, the one-dose Johnson & Johnson vaccine is no longer available in the United States.

Both Pfizer-BioNTech and Moderna vaccines are known as mRNA vaccines. According to the CDC, mRNA vaccines were created in a lab. They essentially teach our bodies how to make a certain type of protein in order to trigger an immune response. That immune response is what produces antibodies. Those antibodies in turn help protect people from getting sick. Both of these drugmakers initially created a vaccine known as a monovalent vaccine, which was focused on the initial strain of COVID. They have since developed a bivalent booster, which targets newer strains of the virus-like Omicron.

The Novavax vaccine is different. It is known as a protein subunit vaccine, which contains pieces of the virus (spike protein) that causes COVID. But it also includes something called an adjuvant that can help our bodies learn how to respond to that spike protein.

The COVID-19 Vaccine Timeline for Kids

There are slight nuanced differences between the vaccines, mostly depending on your child's age and when or if they've had any previous doses. All children can begin receiving the primary doses of the Pfizer-BioNTech and Moderna COVID vaccines beginning at age 6 months. In fact, the CDC recommends it, according to its childhood immunization schedule.

Pfizer-BioNTech (Comirnaty)

In December 2020, Pfizer—working with German company BioNTech—became the first COVID vaccine approved for emergency use by the FDA. It now has full approval for adults and children.

Ages 6 months to 4 years: Children in this age group should receive their first dose of the Pfizer-BioNTech vaccine. Their second dose of the primary series should be given three to eight weeks later. A third dose should be given at least eight weeks after the second. In March 2023, the FDA approved Pfizer-BioNTech's bivalent booster for this age group as well. It should be given at least two months after the child has completed their primary monovalent series.

Ages 5-11 years old: The first two shots in the primary series follow the same schedule as for babies and toddlers. For their third dose, 5-year-olds will receive the updated bivalent Pfizer-BioNTech booster. Kids between 6 and 11 can get either the Pfizer-BioNTech or Moderna bivalent booster. That third dose will come at least two months after their 2nd dose or last booster shot.

Ages 12-17 years old: This age group can get either the Pfizer-BioNTech or Moderna booster as their third dose at least two months after their 2nd dose or last booster.

Moderna (Spikevax)

Shortly after Pfizer-BioNTech in December 2020, Moderna became the second drugmaker to receive emergency use authorization from the FDA for rollout to people ages 18 and up. It too now has full approval for adults and children.

Ages 6 months to 5 years: Like the Pfizer-BioNTech vaccine, kids in this age group are eligible to receive their first dose of the Moderna vaccine. The second dose of this vaccine should then be given four to eight weeks later. Children age 6 months-4 years can only get Moderna's updated booster and that should come at least two months after their second dose. Five-year-olds can either get a Moderna or a Pfizer-BioNTech bivalent booster.

Ages 6-17 years old: Once the first dose is given for this age group, the second dose should be given four to eight weeks later. Kids at this age can then get either the Moderna or the Pfizer-BioNTech bivalent booster as a third dose. It can be given at least two months after their second dose or their last booster shot.

Novavax

The last vaccine to be approved for children is Novavax, although it's only approved at this point for kids ages 12 to 17. Like the other vaccines, it is given in two doses, with the second coming three to eight weeks after the first. The CDC then advises a Pfizer-BioNTech or a Moderna booster at least two months after the second dose.

The Novavax vaccine is protein-based, meaning it doesn't use mRNA technology like Pfizer and Moderna. This might appeal to vaccine-hesitant individuals who prefer a more conventional technology.

Are COVID-19 Vaccines Safe for Kids?

When clinical trials first began, children were largely excluded, which is why COVID vaccine approval took so long. The exclusion was partly for ethical reasons because kids can't fully comprehend and consent to the trials. Also, children have different bodies and immune systems than adults, so experts wanted to understand safety risks thoroughly before starting pediatric testing, says Christine Turley, M.D., Pediatrics Specialist and vice chair of research at Atrium Health Levine Children's.

Once experts learned more about the COVID vaccine, pediatric clinical trials began for children 6 months and up. Researchers didn't find any red flags in clinical trials as they thoroughly evaluated the dosage, side effects, frequency, and other important elements.

Still, some parents may worry about the rapid development of the COVID vaccines. But Dr. Turley stresses all safety procedures have been properly followed in the clinical trials, and only the administrative components have been sped up. "The FDA worked closely with vaccine experts to study a vaccine design for COVID-19," she says. "Trial design usually takes a long time, which contributes to a long time for vaccine approval, but this was all discussed before we even had a candidate."

With COVID vaccines receiving FDA approval for kids, you and your children shouldn't be afraid, stresses Purvi Parikh, M.D., an allergist and immunologist with the Allergy and Asthma Network and co-investigator on the vaccine trials. "Do not be fearful of the vaccine if you are recommended to get it, as the risk of infection may outweigh any risks from the vaccine," she says.

That said, there is something to note: The CDC confirmed some cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart's outer lining) in people 30 and younger who received Pfizer or Moderna vaccines. Symptoms occur mostly in males after the second dose, including chest pain, heart palpitations, and shortness of breath. They tend to occur within a week of getting the injection. Most cases resolve with treatment.

Are COVID-19 Vaccines Effective?

Experts are still studying the COVID vaccine effectiveness in kids and adolescents. One study, published in March 2022 in The New England Journal of Medicine, analyzed data during the Omicron surge. For those ages 12 to 18 years, researchers found vaccine effectiveness was 40% against COVID hospitalization, 79% against critical illness, and 20% against noncritical illness. For younger children ages 5 to 11, the effectiveness against hospitalization was 68%. These numbers reflect a decrease in protection over the past several months—possibly because of the lower dose of the pediatric vaccines, the emergence of more transmissible variants, and longer durations of time since vaccination.

Should My Child Get Vaccinated Against COVID-19?

Parents can weigh the pros and cons of the vaccine, but experts stress the importance of getting it for your children. Kids generally have been spared from the worst of the coronavirus, but there are children still getting sick. As of March 9, 2023, nearly 15.5 million children have tested positive for COVID since the pandemic began. That's about 18% of total cases in the U.S. Sadly, children have also died from the virus, and others have gotten a mysterious and deadly illness called multisystem inflammatory syndrome in children (MIS-C)

"The benefits of vaccination far outweigh any risks," says Dr. Vivek Murthy, the Surgeon General of the United States, during a press conference. "It's easy to forget that not getting vaccinated is a choice that puts our kids at higher risk of getting COVID."

What's more, children can easily pass COVID to parents, grandparents, and those with underlying health issues who might suffer more severe consequences.

For the same reason, caregivers and relatives of children should consider getting the vaccine. "If your child goes to school, parents and grandparents should take the vaccine to protect themselves, especially if you fall into one of those high-risk groups," says Dr. Parikh. "We know children can transmit the infection asymptomatically."

Are COVID-19 Vaccines Safe for Pregnant People?

Organizations like the CDC and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant people receive the COVID vaccine, as the benefits of vaccination outweigh any possible risks.

There are also benefits for your new baby. There's growing evidence a vaccinated birthing parent passes COVID antibodies onto their babies. In one study in 2022, the instance was higher in babies born to vaccinated parents compared to those born to parents who have had COVID but were not vaccinated. Nursing parents can also pass along antibodies to their new babies through their milk.