Here’s what parents need to know about the COVID-19 vaccine for children ages 5-11


All children 5 and up now eligible for the COVID-19 vaccine

Parents can breathe a sigh of relief now that the U.S. Food and Drug Administration (FDA) has issued emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 on November 2, making everyone age 5 and older eligible to receive the COVID-19 vaccine.

But many still have questions, even if they are eager to have their children vaccinated.

We talked to Jason Newland, MD, and Rachel Orscheln, MD, Washington University pediatric infectious diseases specialists at St. Louis Children’s Hospital, to get answers to some of the most frequently asked questions about children, COVID-19 and the vaccine.

What kinds of trials were done to prove the COVID-19 vaccine is safe and effective in children?

The clinical trial began early in 2021 to test the safety and effectiveness of the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11. The trial also aimed to establish the optimal vaccine dose for children in that age group.

About 2,200 children were enrolled in the trial at sites around the world.

Children in the trial received either two doses of the vaccine or two doses of a placebo. Researchers compared how many COVID-19 infections occurred in each group. The results clearly showed that those who received the vaccine had fewer cases of COVID-19 and those cases were milder than in the placebo group.

What about vaccine trials for children age 4 and younger?

Clinical trials evaluating the COVID-19 vaccine for children from ages 6 months to 4 years are currently underway. Results are expected in early 2022.

Why is it important to have my child vaccinated against COVID-19?

Widespread vaccination of adults and children is the way to end the pandemic.

Not only that, but numerous children across the United States have been hospitalized with severe COVID-19 and more than 600 children have died. Data clearly shows that vaccination decreases an individual’s chances of becoming infected with COVID-19 or becoming seriously ill and dying if they do become infected.

Additionally, studies have shown that vaccinated individuals are less likely to spread COVID-19. Vaccinating your child adds a layer of protection for your entire family, especially those at greater risk of severe disease, such as grandparents or family members with underlying conditions or chronic diseases.

How much protection against COVID-19 does the vaccine offer to children?

As with adults and teens, the clinical trial showed that the Pfizer COVID-19 vaccine is highly effective — 90.7% — in preventing symptomatic infection in children ages 5-11.

No vaccine can prevent 100 percent of infections, but among adults and children 12 and older, data show that the COVID-19 vaccine is especially effective in keeping those who do become infected from having to be hospitalized. It’s the difference between having mild to moderate cold-like symptoms and having a severe illness.

But I thought children get very mild symptoms or no symptoms at all if they are infected with COVID-19?

There’s a misconception that children don’t get seriously ill or die from COVID-19. While most children who get COVID-19 will recover without needing hospitalization or developing complications, some do end up seriously ill and some don’t recover.

We’ve seen that one of the most serious complications of COVID-19 in children is multisystem inflammatory syndrome (MIS-C), which can affect many parts of the body, including the heart, lung, brain, kidneys, eyes and intestines. Here in the U.S., more than 4,000 children have been diagnosed with MIS-C and more than 40 have died from it.

The Delta variant of the COVID-19 virus that is now circulating is much more contagious than the original virus. Because more children have become infected with COVID-19 with the Delta variant, more have developed severe disease and more have been hospitalized and more have died.

The COVID-19 vaccines have been shown in studies for both children and adults to be very effective against the Delta variant.

If my child has had COVID-19, does he or she still need to be vaccinated?

People do develop some natural protection after having COVID-19. This protection is about 80 percent effective against re-infection. But we also know those antibodies weaken and people do get re-infected with variants.

The data is clear to show that vaccination is more protective for a longer time than the protection from an infection. That’s why children should be vaccinated even if they’ve had a COVID-19 infection. Experts suggest waiting at least a month before getting vaccinated to limit the side effects.

Is the vaccine dose and schedule for children the same as for adults and teens?

The dose of COVID-19 vaccine given to kids ages 5-11 will be about one third of that given to teens and adults.

The clinical trial has shown that the smaller dose is effective in maintaining protection against the virus while reducing the chances of side effects from the vaccine.

Like adults and teens who received the Pfizer vaccine, children will receive two shots spaced at least 21 days apart. The shot is given in the arm or the thigh.

The vaccine reaches full effectiveness about two weeks after the second shot is given, with antibody levels in children comparable to that of adults who receive the series.

What are the side effects in children from the COVID-19 vaccine?

In the clinical trial, the vaccine side effects for children have been like the side effects for adults and teens — generally mild and short-lived, lasting only a day or two. They may experience a sore arm, low-grade fever, nausea, headache or muscle aches.

Children can go to school the day after the shot if they feel okay. You can give them acetaminophen or ibuprofen after they start to feel bad — not before.

A few, extremely rare cases of inflammation of the heart muscle, called myocarditis, have been reported in teens and young adults after receiving the second dose of the vaccine. Most patients with myocarditis who received care responded well to medicine and rest and felt better quickly.

No children in the Pfizer trial for 5- to 11-year-olds experienced myocarditis or a serious side effect.

The CDC is monitoring COVID-19 vaccinations across the country very closely for side effects. The data shows that the effects of COVID-19 are much worse than vaccine side effects.

What’s the recommendation for spacing between the COVID-19 vaccine and the flu shot, MMR (measles, mumps, rubella) or other vaccines required for school-age children?

The really good news is there’s no requirement to space the COVID-19 vaccines from other vaccines, so you can give them at the same time as the measles vaccine, the diphtheria vaccine or any other childhood illness vaccines.

Does the vaccine cause infertility or other developmental problems that parents need to worry about?

There is no evidence that the COVID-19 vaccine, or any other vaccine for that matter, impacts fertility. There’s no biological mechanism for that to happen.

There is no evidence that the COVID-19 vaccine causes developmental problems.

Should children who are vaccinated still wear a mask to school or in public?
At this time, and until community vaccination rates are higher and the community COVID-19 cases are lower, masks are recommended in schools and in public as an additional layer of protection against COVID-19.

Most transmission of COVID-19 happens within households. So, masking at school and in public not only gives the child protection against the virus, it reduces the chance the child will bring the virus home and infect unvaccinated or at-risk people the child lives with.

As vaccination rates rise, especially among the large unvaccinated population of children, we may be able to stop masking. But for now, the recommendation is that everyone, vaccinated or not, continue masking.

Why have more children become sick with COVID-19 this year than last year?

We can thank the Delta variant for that. Delta is more infectious than other strains of the virus, and when you have a large, unvaccinated population — like children — they’re going to be impacted more.

As our community has begun to do activities like before the pandemic, more unvaccinated and even vaccinated have become infected. One concern is unvaccinated adults interacting with these vulnerable children especially in households. We have seen some signs of the Delta variant surge starting to wane, but it’s prudent to be vaccinated to help prevent another variant that comes along.

How does vaccination status affect quarantine guidelines?

Once vaccinated, children will not have to quarantine if they are exposed to someone infected with COVID-19. This is very good news because of the mental toll and strain quarantining takes on families and children.

What is the most important thing parents should know about the COVID-19 vaccine?

The COVID-19 vaccines have been proven safe and effective by data from extensive testing and parents need to realize that vaccination — of children and adults — is the best protection against the virus and the best way to get us out of this pandemic.

Vaccines for all ages are available through several BJC HealthCare locations, other members of the Pandemic Task Force, or retail pharmacies and mass vaccine sites across the region.

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