Here's what parents should know about the COVID-19 vaccine's safety, effectiveness, and availability for kids.

After months of struggling through virtual schooling, telecommuting, and social distancing, parents finally have a piece of good news: COVID-19 vaccines are being rolled out across the country, and everyone 5 and up is eligible to get vaccinated.

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) also approved booster shots for everyone 12 and up at least five months after receiving their initial doses. And certain immunocompromised children ages 5 to 11 can receive an additional dose 28 days after their second shot.

"Vaccination and getting a booster when eligible, along with other preventive measures like masking and avoiding large crowds and poorly ventilated spaces, remain our most effective methods for fighting COVID-19," said Acting FDA Commissioner Janet Woodcock, M.D, in a December 9 statement.

Those under 5 years old are still ineligible for the COVID-19 vaccine, and they might have to wait a little longer. On December 17, Pfizer announced that two doses of the pediatric vaccine didn't trigger a sufficient immune response in children ages 2 to 4 years old, according to The Washington Post. (The immune response was adequate in those 6 months to 2 years old.) Pfizer plans to conduct trials with a third shot, given least two months after the initial vaccine series, for this younger age group. Emergency use authorization will depend on the results.

Here's everything you need to know about the COVID-19 vaccine and children.

COVID-19 Vaccine Timeline for Kids

In May, the Pfizer vaccine was approved for children 12 and up (it has full FDA approval for those 16 and older). On November 2, children ages 5 to 11 got the go-ahead to receive a smaller dose of Pfizer under emergency use authorization. The approval came after recommendations from the FDA and CDC, and it's for two doses of 10 micrograms each, which is about one-third of the dose given to adults and adolescents.

Now only those under 5 years old are ineligible for the COVID-19 vaccine. The approval timeline for these younger kids depends on clinical trial results; Pfizer is currently including a third shot in their pediatric trials because the initial vaccine series didn't produce a sufficient immune response in children ages 2, 3, and 4 years old. If this third shot increases immunity, Pfizer is expected to submit the data to regulators in the beginning of this year, says The Washington Post.

And what about Moderna? On May 25, it announced results of its TeenCOVE study, which included more than 3,700 participants between ages 12 and 17 years old. Two doses of the vaccine proved 100 percent effective in this age group—and one dose was 93 percent effective—with no major side effects. And, on October 25, Moderna revealed a trial of more than 4,700 participants found its vaccine is safe and has a positive immune response for kids ages 6 to 11. Those results are not yet peer-reviewed or published. Moderna is also conducting trials on kids older than 6 months, and results are expected sometime soon.

Additionally, Johnson & Johnson announced pediatric testing plans for children 12 and older, which will be followed by tests involving newborns and adolescents.

parents with little girl getting vaccinated, everyone wearing face masks
Credit: Getty Images

Is the COVID-19 Vaccine Safe for Kids?

When clinical trials first began, children were largely excluded, which is why many haven't received COVID-19 vaccine approval yet. 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 want to understand safety risks thoroughly before undergoing 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-19 vaccine, pediatric clinical trials began for children 6 months to less than 12 years old.

Researchers haven't seen any red flags in clinical trials as they thoroughly evaluated the dosage, side effects, frequency, and other important elements. Experts understand that children have different immune systems and body functions than adults, and they only approve a pediatric vaccine if they're absolutely sure of its safety.

Indeed, Pfizer's pediatric vaccine involves a lower dose than what's given to adults and adolescents; experts came up with the dosage based on early trials that assessed safety. According to The New York Times, kids between 5 to 11 years old are given two doses of 10 micrograms each, which is about one-third of the dose given to adults and adolescents. Children under 5 years were initially given two doses, each with three micrograms, in clinical trials. Now they will be given a third dose in hopes of increasing immune response.

Still, some parents worry about the rapid development of the COVID-19 vaccines, since they received approval in record time. But Dr. Turley stresses that 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."

When COVID-19 vaccines receive FDA approval for kids, you shouldn't fear getting one, 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 risk of infection may outweigh any risks from the vaccine," she says. Widespread vaccination will help stop COVID-19 in its tracks, letting everyone get back to life as we knew it. 

That said, here's something to note: The CDC recently confirmed some cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of heart's outer lining) in people 30 and younger who received Pfizer or Moderna. Symptoms occur mostly in males after the second dose, and they include chest pain, heart palpitations, and shortness of breath. Most cases resolve with treatment. While myocarditis after vaccination remains a very rare event, medical organizations are further studying a link to the mRNA vaccines in young people. The CDC still recommends that everyone 12 years of age and older get vaccinated. Because of myocarditis and pericarditis concerns, Sweden and Denmark recently paused Moderna distribution for younger people.

Is the COVID-19 Vaccine Effective?

So far, data on COVID-19 vaccine effectiveness in kids looks promising. Indeed, according to the FDA, "Immune responses of children 5 through 11 years of age were comparable to those of individuals 16 through 25 years of age. In addition, the vaccine was found to be 90.7 percent effective in preventing COVID-19 in children 5 through 11." In adolescents and adults, the vaccines have been shown to reduce the risk of severe illness, hospitalization, and death—even with the highly transmissible Delta and Omicron variants.

Booster shots have also been approved for kids ages 12 and up, at least five months after their primary vaccine series. This should help protect against waning immune response over time. And certain immunocompromised kids ages 5 to 11 can also get a third dose of the vaccine 28 days after their second shot.

Even though clinical trial results weren't satisfactory for children under 5 years old, experts are working to make a safe, effective vaccine for this younger age group. As of now, this might involve including a third low-dose shot in the vaccine series, but we need to wait for clinical trial results to learn more.

Should My Child Get the COVID-19 Vaccine?

Parents can weigh the pros and cons of the vaccine, but when your kids are eligible, experts stress the importance of getting it. Kids generally have been spared from the worst of the coronavirus, but about 17.4 percent of COVID-19 cases are in pediatric patients, according to the American Academy of Pediatrics. Several kids have died from the virus, and others have gotten a mysterious and deadly illness called multisystem inflammatory syndrome in children (MIS-C)

A study published by the CDC showed that the hospitalization rate for adolescents with COVID-19 was 2.5 to 3 times higher than that age group's rate for the flu. "The benefits of vaccination far outweigh any risks," said Dr. Vivek Murthy, the Surgeon General of the United States, during a recent 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-19 to parents, grandparents, and those with underlying health issues who might suffer more severe consequences. "We can't get community immunity until we know that known carriers are protected," says Dr. Turley. If majority of the population does not get vaccinated, "it will be harder to stop the spread of COVID-19" in America, adds Dr. Parikh.

For the same reason, it's also vital for caregivers and relatives of children to receive 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." 

Finally, Dr. Murthy recently stressed that vaccination opens up activities with friends and at school that have been severely curtailed, from "sleep overs, and birthday parties to school plays and soccer games." He adds: "Ultimately the vaccine is a pathway to getting back to the rich parts of life that bring our kids joy and fulfillment."