Covid-19 vaccine: What to consider for children under five?

Where can parents go to get their children vaccinated? Which one should they choose? What kind of side effects can be expected, and how should they be treated? Can the Covid-19 vaccine be given with other childhood vaccinations? And how long should children who have just contracted Covid-19 wait before they get the shot?

To help us answer these questions, I spoke with CNN Medical Analyst Dr. Lena Win, MD, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute School of Public Health. She is also the author of Lifelines: A Doctor in the Fight for Public Health and a mother of two children under the age of five.

The following conversation has been edited slightly for length and clarity.

CNN: Let’s start with your family. You have a 4-year-old and a 2-year-old. Have they been vaccinated yet?

Dr. Lina Wen: yes! I called my pediatrician’s office Once the FDA cleared the vaccine to tell them I want my children to be vaccinated as soon as possible. The earliest appointment was this past Monday, about a week after children in the 6-month to 5-year-old group started getting their shots.

CNN: How did it go?

Wen: It was no different than any other vaccination appointment. My children used to receive vaccinations in childhood. They went to the office. I signed in and signed some forms, and they got their snapshots from the nurse. There were no tears. Both children were very excited by their colorful bandages.

On the other hand, I felt emotional. My daughter was born in April 2020, right at the beginning of the pandemic when so much was unknown and our lives were filled with fear. My son has had many disruptions in his life due to Covid-19, including closing his school and not being able to get play dates.

Our family has been waiting a long time for this moment. It’s been a really long time, because it’s been over a year and a half since adults started getting their vaccinations. I am so relieved that my children are now able to receive the same exceptional level of protection that everyone 5 years old and older can get.

CNN: Which vaccine did you choose?

Wen: My kids got the Moderna vaccine. That’s what our pediatrician’s office has at the moment.

I could see why parents with a choice would make either decision. Moderna vaccine is two doses compared to (with) the three doses of Pfizer, and many parents may prefer to complete the full series and again quickly. The Pfizer vaccine has been given to children 5 years of age and older since last November. Preliminary studies also suggest that Pfizer may have milder side effects due to the lower dosage. Some parents may prefer it because it has a longer history and possibly fewer side effects. Both vaccines are safe and effective, and I think a lot of parents will do what I did and choose what’s more appropriate.

CNN: Where should parents go to get the vaccine if the pediatrician’s office doesn’t offer it?

The US Food and Drug Administration has approved Covid-19 vaccines for children under the age of five.  What should parents know?

Wen: I still call the pediatrician’s office and ask for recommendations. They may have a list of local pharmacies that will vaccinate young children. Be sure to check ahead as most pharmacies likely won’t be equipped to vaccinate very young children, so it’s important to know in advance which ones will. When calling, tell them the exact ages of your children. Some pharmacies may apply additional age restrictions such as vaccinations only for those 3 years of age and older.

The federal government website is also a great resource. You may also consider contacting your local health department in your city or state as they may have temporary vaccination clinics set up as well.

CNN: What kind of side effects can be expected, and what can parents use to treat their children?

Wen: The types of side effects are similar to what can be seen with many other routine childhood immunizations. Children can develop afternoon arms or redness at the injection site. They can have a fever or be irritable and cranky. These symptoms are generally mild and disappear within a day or two. Lots of kids don’t have any side effects – my kids don’t.

The CDC doesn’t recommend sedation — which means your child shouldn’t be given Tylenol or ibuprofen before the vaccination, in anticipation of possible side effects. However, if your child develops a fever, you should definitely give Tylenol or ibuprofen in the appropriate doses for his age and weight.

CNN: Can the Covid-19 vaccine be given with other childhood vaccinations?

Wen: Yes, the Centers for Disease Control and Prevention (CDC) said the Covid-19 vaccine can be given at the same time as other childhood vaccinations. A different injection site is used – eg, an injection for Covid-19 in one leg and another vaccine in another leg.

It is really important for children to be up to date with other vaccinations to prevent other infectious diseases. Be sure to check with your pediatrician to see if other shots are scheduled as well.

CNN: Should parents choose a specific day of the week to give the vaccine?

Children get long-term COVID disease, too, and it can manifest in unexpected ways

Wen: Most children will not have symptoms significant enough to miss school. However, know that there is a chance that they will feel strange or more tired, and have a plan for the next day after the vaccination. If they had to stay home from school, would you have a backup plan for childcare?

CNN: How long do kids who have just contracted Covid-19 have to wait before they get the shot?

Wen: The Centers for Disease Control and Prevention (CDC) says it’s a good idea to administer the vaccine after symptoms have passed and the post-infection isolation period has ended. The agency also says it may be possible to wait three months after the last infection.

I think this is good advice. Recovery from a recent infection provides some protection for two to three months. I think it is reasonable to wait two months after the last infection to start the vaccine series, but also keep in mind that infection alone does not provide nearly as strong or long-lasting protection as a hybrid immunity from infection and vaccination. The CDC recommends that your children be vaccinated, even if they become infected.

CNN: And what about parents who aren’t sure, who want to wait and see?

Wen: All parents and caregivers want to do what is best for our children. Many parents will be very excited about vaccinating their children. I’m definitely in that camp, with a lot of medical moms I know.

Other parents may want to wait and see the experiences of those who want to go first. I would encourage families on the fence to speak with their pediatrician as well as consult credible specialist organizations, such as the CDC and the American Academy of Pediatrics.

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