Younger Children & the Covid Vaccine

Pediatric Specialist Weighs in on Parents’ Vaccination Questions 

Now that kids as young as 5 can get the Covid vaccine, parents have questions. Safety questions, logistical questions, questions about long-term side effects. As the vaccination of our nation’s youth continues in earnest, there is no shortage of collective querying – reflecting both excitement and angst. 

The FDA cleared the way for this phase in late October by authoring emergency use of Pfizer’s Covid vaccine, at one-third the adult dose, for children ages 5 to 11. The CDC followed suit with its own recommendation, removing the last hurdle to a national roll-out. On Nov. 3, Vermont began officially vaccinating children in this age group through community and school-based sites as well as pediatricians’ offices.

We spoke with UVM pediatric specialist Rebecca Bell, M.D., in advance of her guest appearance at the Governor’s press conference on Nov. 2 and a livestream Q&A with parents Nov. 4 to get the scoop on the vaccine for younger kids. Bell, the current chair of the Vermont chapter of the American Academy of Pediatrics (AAP-VT), works in the pediatric intensive care unit at UVM Children’s Hospital. Throughout November and December, AAP-VT is hosting a series of virtual “family forums” with pediatricians from across the state answering questions directly. Learn more and register here.

“Pediatricians in Vermont are really excited that another segment of our population is going to be vaccinated,” Bell said in an interview Nov. 1. “I feel very reassured by the data that was presented at the FDA review.”

Yes, Children Get Covid

Acknowledging the cautionary statements made by several of the FDA advisory committee members, Bell emphasized that the committee “made the decision in the context of an ongoing pandemic that is causing illness, hospitalizations and death in this age group.” It’s an important note, she said, because Covid’s full extent in younger children has been underappreciated.

Bell said one of the most common questions parents ask is: “Does my child even need to be vaccinated?” It’s a question driven by the false perception that children don’t get Covid, Bell said. That perception likely grew out of the early public-health decisions to prioritize vaccination for older people and others deemed at high risk for serious illness or death from Covid. These decisions were in turn driven by the realities of the limited vaccine supply at the time and the need to protect the most vulnerable first. 

There was never a time when children weren’t at risk, Bell said. Rather, children were at less risk relative to older folks and those with pre-existing health conditions.

Now that there is abundant vaccine available in the U.S. and the bulk of people in high-risk groups are vaccinated, it’s time to focus on children. As the rest of the population gradually gets vaccinated, the absolute risk to children of becoming infected with Covid becomes clearer. This is evident in the rising number of new cases in children under 12 and the rising numbers of children being hospitalized for Covid. That trend is likely to get worse before it gets better, Bell cautioned.

“It’s time to shift our framing from relative risk to absolute risk” in thinking about children, Bell said. At the same time, it’s important to evaluate “the risks and benefits of the vaccine vs. the risks of getting Covid.”

How Do I Know The Vaccine is Safe for My Kid?

Another common concern of parents is long-term safety of the vaccine. It’s a tough question to answer, of course, because there is no long-term data on Covid vaccine, simply by nature of the fact that they have only been available for a year or so. What we do know, Bell said, is gleaned from experience with other childhood immunizations. That record shows that most vaccine side effects show up in the first hours or days, up to about 6 to 8 weeks post-jab, she said.

She doesn’t anticipate the mRNA vaccines to be different because they act on the same principle as other vaccines, which is to present some information to the immune system. The immune system then responds, in the form of making antibodies specific to the information presented. In traditional vaccines, the information is a piece of protein or inactivated virus.In the case of mRNA vaccines, the information presented is a recipe to make the spike protein on the sar-cov-2 virus

Monitoring for Myocarditis Post-Vaccine

One side effect being closely watched in children is myocarditis, an inflammation of the lining of the heart muscle. The condition showed up in the vaccine monitoring system as a rare adverse effect appearing within the first two weeks in teenagers who received the vaccine. Boys in the 16-to-17-year-old range are primarily affected, Bell said. In most cases, the course has been fairly mild, and children have recovered. As such, vaccine-related myocarditis appears to be substantially less problematic than myocarditis from viral infections, which can cause serious dysfunction.  

Myocarditis was not seen in any of the 5- to 11-year-old participants in the clinical trial for Pfizer’s lower-dose children’s vaccine, but that’s not surprising given its rarity and the relatively small number of children enrolled who received vaccine (3,000) vs. placebo (1,500.) The heart condition showed up in older children only after millions of doses were administered. In part due to the experience in older children, public health experts are calling for close monitoring of this side effect in particular. The primary complaint related to myocarditis is chest pain, Bell said, and sometimes difficulty breathing. In adolescents, symptoms appeared within two weeks following the second dose.

Vaccine Prepares Immune System for Sar-Cov-2 Exposure

The Vermont Department of Health officially opened the state-run vaccination registration system to children 5 to 11 on Nov. 3. Governor Phil Scott and his administration outlined the plan the day before in the bi-weekly press conference. The distribution network relies on community-based vaccination sites and school-based clinics at its core. Pediatricians will also be receiving vaccines for parents who prefer to go to their child’s healthcare provider. 

Bell, who is mom to a 4-year-old and a 6-year-old, will be signing up her older child for the jab, and hopes others will too. She sees a “huge divergence” in how Vermont families are dealing with pandemic risks.  She worries about kids living with unvaccinated family members because she sees them getting Covid. Some of them end up in the ICU at Children’s Hospital. 

“Sars-cov-2 is not going away. We are all going to be exposed to it. Our children are going to be exposed to it, and probably many of them will be infected with it at some point in their lives. What can we do to prepare the immune system for the eventuality of exposure? Getting kids vaccinated is one way that we can prepare for that eventuality.”

~ Rebecca Bell, M.D., pediatric specialist, UVM Children’s Hospital

Bell remains hopeful. “We have an amazing opportunity right now. We’ve managed to limit the number of children who’ve gotten Covid-19 so far in this pandemic, and now we can vaccinate them.” 

Learn More and Find Vaccine Resources

Join one of the AAP-VT’s family forums with Vermont pediatricians for live virtual Q&A’s throughout the months of November and December. Find the schedule and sign up here.

Watch the Nov. 3 UVM Children’s Hospital live Q&A, Let’s Talk About Vaccines for Kids 5-11, with Rebecca Bell, M.D. and Lewis First, M.D. 

Watch the Governor’s press conference from Nov. 2, where officials explained the state’s vaccination roll-out for children 5 to 11.

Visit the Vermont Department of Health’s Vaccine Dashboard for more information on getting the Covid vaccine for kids 5 to 11. 

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Blog written by Brenda Patoine on behalf of VCN/Vermont Care Partners for COVID Support Vermont, a grant funded by FEMA and the Vermont Department of Mental Health

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