COVID-19 vaccines for children under 5: What parents need to know

The wait is over. Children ages 6 months to 5 years are now eligible to receive the COVID-19 vaccine. With this authorization, parents of young children may have questions about the vaccine and what to expect after.

Here, Dr. Vivi Tran, a CHOC pediatrician, answers parents’ common questions about the COVID-19 vaccine for children under 5 years.

Can kids younger than 5 years receive the COVID-19 vaccine?

Yes. Children ages 6 months to 4 years are now authorized to receive the COVID-19 vaccine from Pfizer-BioNTech (Pfizer). Pfizer’s vaccine has already been approved for kids in the age groups ages 5 to 11 years and 12 to 18 years.

Children ages 6 months to 5 years are also authorized to receive the COVID-19 vaccine from Moderna. Moderna’s vaccine is now authorized for children ages 6 to 11 years, teens ages 12 to 17 years and adults 18 years and older.

Upon reviewing the data from Pfizer and Moderna’s clinical trial, the U.S. Food and Drug Administration has given emergency use authorization, and the Centers for Disease Control and Prevention (CDC) has recommended the vaccine be administered to children under 5 years.

Why did the vaccine approval for kids under 5 years take so long?

COVID-19 vaccine manufacturers needed time to conduct clinical trials to determine the safety, efficacy and dosage size of the vaccine for young children. The good news is that the extended timeline gave Pfizer and Moderna the chance to ensure that their vaccine would be both effective and extraordinarily safe for children under 5 years.

Can children under 5 years get the Pfizer COVID-19 vaccine? Is it safe?

Yes. The Pfizer vaccine has proven to be safe for children ages 6 months to 4 years. 

Pfizer’s clinical trials showed that after the two-dose vaccine, the immune response for some children wasn’t as strong as desired. The third shot is crucial for Pfizer’s vaccine because two doses offered little protection.

The FDA had originally sought to fast track the first two doses in February, but Pfizer postponed its submission because the data wasn’t good enough. Now, the three-dose vaccine has been proven to be 80% effective at preventing illness from the omicron variant.

The Pfizer vaccine, as well as the Moderna vaccine, is an mRNA vaccine. When the vaccine is injected, mRNA – a strip of genetic material – enters a body’s cell and prompts the cell to build copies of spike proteins. These spike proteins are the bumps that protrude from the surface of coronavirus particles. The body’s immune system then learns to spot these spike proteins and produces antibodies that block the virus from entering healthy cells in the future.

We have no reason to expect that children would tolerate the vaccine less favorably than adults would.

Can children under 5 years get the Moderna COVID-19 vaccine? Is it safe?

Yes. The Moderna vaccine has proven to be safe for children ages 6 months to 5 years. 

Moderna’s vaccine is administered in two doses for kids ages 6 months to 5 years. The shots are dosed at 25 micrograms, which is one-fourth of what adults receive.

According to Moderna’s clinical trials, the vaccine was about 51% effective at preventing illness from omicron for kids six months to 2 years, and about 37% effective for kids ages 2 to 5 years.

Moderna plans to conduct further clinical trials on a third dose targeting the omicron variant in this age group over the summer and ask the FDA to review the data as soon as possible.

How many doses of the COVID-19 vaccine will kids ages 0-5 years receive?

The FDA has granted emergency use authorization to administer three doses of Pfizer’s COVID-19 vaccine to children ages 6 months to 4 years and two doses of Moderna’s COVID-19 vaccine to children ages 6 months to 5 years.

Learn more from a CHOC expert about how to protect your family against the omicron variant.

Are the vaccine vials for children under 5 the same as for older children and adults?

No. The vials of the Pfizer vaccine for children under 5 years will contain 3 microgram doses. The vials for children ages 5 to 11 years contain 10 microgram doses, and the vials for older children, teens and adults contain 30 microgram doses. This means that pharmacies and doctors’ offices will have separate stocks for these populations. They won’t, for example, be able to draw a smaller dosage amount from an adult vial to give to a young child. They will also need to use smaller needles to administer the vaccine to younger children.

Vials of the Moderna vaccine for children 5 years and under will contain 25 microgram doses. This is one-fourth of the dose that adults receive. The vials for children 6 to 11 years contain 50 microgram doses, one-half of the vials for adults. Teens ages 12 to 17 years will receive 100 microgram doses, which is the same as adults.

Is the J&J Janssen COVID-19 vaccine available for children under 12?

No. The one-dose J&J Janssen COVID-19 vaccine is recommended for adults ages 18 years and older. J&J Janssen is conducting research on the vaccine’s response in younger age groups.

Is the Moderna COVID-19 vaccine available for children under 12?

No. The Moderna vaccine is only authorized and recommended for kids 6 months to 5 years. Moderna will be seeking authorization from the FDA for the vaccines for kids 6 to 11 years and 12 to 17 years.    

Even with the vaccine, it seems like a lot of kids are getting sick from COVID-19 variants. How can I prevent my kids from getting sick?

The best thing to do is get your young children vaccinated and surround them with people who have been fully vaccinated, as well as boosted, if eligible, against COVID-19.

In addition, keep doing what you’ve been doing all along to keep your children safe:

• teach your children over age 2 how to appropriately wear a mask, and wear high-quality and well-fitted masks in public spaces and when around people from outside your household;
• wash hands frequently and thoroughly;
• limit your activities to open spaces without crowds;
• stay home when sick; and
• ensure you and your children are current on all vaccines they are eligible for, especially this year’s influenza vaccine.

What are the COVID-19 vaccine side effects for kids under 5?

Pfizer and Moderna state that their COVID-19 vaccine was well-tolerated by its clinical trial participants. The side effects are generally comparable to those observed in older children and adults. The most commonly reported side effects include:

• Pain where the shot was given
• Fatigue
• Headache
• Chills
• Muscle pain
• Fever
• Joint pain

Any side effects should be relatively short-lived and ease within 24 hours. Because children have more robust immune systems, it’s possible that they may feel these side effects more strongly than adults would. This is a sign that their immune system is mounting a response against the virus.

Although it is not recommended to administer an over-the-counter pain reliever to your child as a preventative measure for side effects before to their vaccine, it is OK to administer an over-the-counter pain reliever following their vaccine to ease any side effects.

Why should my child under 5 receive the COVID-19 vaccine?

The American Academy of Pediatrics (AAP) reported data that since the beginning of the pandemic, about 13.5 million children have been infected with COVID-19 — which is about 18% of all U.S. cases. Among states reporting, children ranged from 1.3 to 4.6% of their total cumulated hospitalizations. The Centers for Disease Control and Prevention (CDC) puts the pediatric death toll at 1,257 children under 18 years in the United States, representing 0.1 percent of total COVID deaths and 0.01 percent of pediatric COVID-19 cases.

Even one child death is too many. This is why we urge vigilance against COVID-19 and full vaccination, once eligible. Most children who contract COVID-19 will become infected from other adult family members. So, protecting yourself and providing a cocoon around our kids is one of the most successful strategies for protecting our youngest children who are unable to be vaccinated. Additionally, schools and childcare centers are doing a tremendous job of ensuring these environments are safe.

Can my child receive the COVID-19 vaccine at CHOC?

Pediatricians in CHOC’s primary care network are offering the vaccine to kids under 5 years. Please call your pediatrician for an appointment.

Other community clinics may also be offering the vaccine to kids under 5 years. Visit myturn.gov to find options and make an appointment in your zipcode.

Even with vaccines, all of the uncertainty from the ongoing COVID-19 pandemic has been difficult for my family. How can we feel better?

We understand completely. More than two years into the pandemic, parents around the world are burnt out after shouldering so much uncertainty, decision making and sacrifices. Please keep going. You’re a superhero and you’re doing a great job.

Remember that no one can pour from an empty cup. Take time for yourself, and try these practices suggested by CHOC pediatric psychologists to help prevent burnout:

1. Build self-care into your routine. This can be simple like making and enjoying your morning coffee; taking the dog on a walk; or paying attention to what you notice when looking out the window.
2. Exercise consistently. Try taking a walk around the neighborhood; going on a family hike; riding bikes; taking stretch breaks; or taking the stairs. With any choice, the length of time is less important than consistency.
3. Prioritize sleep. Irritability, anxiety and decreased focus are all side effects of sleep deprivation. Aim for seven to eight hours a night of sleep and be consistent with sleep and wake times.
4. Cut yourself some slack. Reframe your goals to reduce pressure. We all need a little more grace these days.
5. Rely on your support system. Reach out to family, friends and neighbors for help when you need it.
6. Reduce media consumption. Increased media consumption has led to increased anxiety and depression. Schedule time away from devices and news.
7. Reflect on yourself. Get into the habit of rating how you are feeling mentally on a one-to-10 scale. Track this and make changes if you need to.

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