Children And The COVID-19 Vaccine: Everything You Should Know

Children aren't currently eligible for the COVID-19 vaccines, but scientists are working around the clock to ensure the next generation is safe and vaccinated. Teenagers under the age of 16 are expected to get vaccinated in the fall. Children of elementary school age are scheduled to be vaccinated early 2022, says CNBC.

There are concerns that it's unnecessary to vaccinate children who are low risk, but John Hopkins Medicine says the risk of severe infection or dying is always present. Also, unvaccinated children can transmit the virus to others. "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," Purvi Parikh, MD, an allergist and immunologist with the Allergy and Asthma Network, told Parents. "We know children can transmit the infection asymptomatically."

Here's what you need to know about vaccinating children against COVID-19.

There is no specific date on when the vaccine will be approved for kids

The currently approved COVID-19 vaccine developed by Pfizer is approved for teens over the age of 16. If all goes well, according to Time, "adolescents will likely become eligible for vaccines at some point in 2021," and "after that, manufacturers will likely keep working their way down in age [with] younger children and babies ... the last to become eligible for the shots." The lag in approval is because scientists are making sure the vaccines are safe and effective.

Younger children can develop a different immune response from the average vaccinated adult. "Children are not just little adults," Buddy Creech, the director of Vanderbilt University's Vaccine Research Program and an investigator in Moderna's pediatric trials, told CNN Health. "They have immune systems that look a whole lot like adults, but they have a different level of training, they've seen fewer viruses and they have fewer health problems."

Afterward, scientists expect to continue gathering more safety data and information on the vaccine-induced immune response in younger children such as toddlers and babies. Time explains that getting each age bracket vaccinated is necessary to keep people safe from COVID-19 infection and reach herd immunity.

Children currently do not need a vaccine to go back to school

Children are at a lower risk than adults of having a severe illness or dying from the coronavirus, but they will need to get a vaccine eventually. However, more research is finding that this shouldn't deter students from going back to school in person. A December 2020 study from the CDC found going to school in-person was not a significant risk for children as long as they continued to social distance and wear masks.

A February 2021 article in The New England Journal of Medicine found only 15 kids (about .77% of 100,000 children from the age of 1 to 16 years) were admitted to the ICU after attending school. Four of the children had an underlying health condition, and no one had died. A December 2020 study found children were more likely to be exposed to COVID-19 in their household.

A more considerable risk may be missing out on school than being exposed to COVID-19. According to Stat, closing down schools has caused children to be deprived of valuable mental health and disabilities resources. There's also a higher risk of child abuse going unnoticed by school officials.

Pfizer is starting a vaccine clinical trial for kids as young as six months

Pfizer has begun testing their vaccine on children as young as six months old. The study would be the second pediatric trial for Pfizer as they began testing the vaccine in children 12 to 15 years old in January 2021.

"We're encouraged by the blinded data that we've seen for the 12- to 15-year-olds," William Gruber, Pfizer's senior vice president of vaccine clinical research and development, told Stat. "That looks very similar to what we saw in 18- to 25-year-olds. We're now going to move judiciously down to 5 to 11."

According to Stat, the trial will test 144 children ranging from 6 months to 12 years old. They will use three different doses of the vaccine and evaluate how the immune system responds to the vaccine dose and any potential side effects. Since children don't have many symptomatic infections, researchers will measure antibody levels and if the vaccine produces a similar antibody response as an adult.

Clinical trials are underway in teens and adolescents

Both Moderna and Pfizer are conducting pediatric clinical trials on adolescent children ranging from 6 to 15 years old. On March 31, 2021, Pfizer released phase 3 trial results showing that the vaccine was 100% effective and safe in children from 12 to 15 years old. They also showed antibodies specific for neutralizing the coronavirus.

"The initial results we have seen in the adolescent studies suggest that children are particularly well protected by vaccination, which is very encouraging given the trends we have seen in recent weeks regarding the spread of the B.1.1.7 UK variant. It is very important to enable them to get back to everyday school life and to meet friends and family while protecting them and their loved ones," Ugur Sahin, CEO and co-founder of BioNTech, told a Pfizer press release.

Moderna has a study called TeenCOVE that, as of this writing, will be testing their two-dose vaccine on adolescents 12 to 17 years old and evaluating their response for 13 months. Moderna also reports testing their mRNA vaccine on children 6 months through 11 years old with their first participants already vaccinated.

Vaccinated family members protect children

Parents may feel helpless in how to best protect their children from COVID-19 infection. KidsHealth recommends anyone over the age of 16 should get vaccinated whenever they become eligible. Vaccinate Your Family explains that getting vaccinated lowers the chances for an infectious disease to spread to others. It also helps people who do not have fully developed immune systems, including infants, who have not received all their immunization shots.

"While the vaccinated adults can visit other fully vaccinated people, either at work or at home or in the neighborhood, it doesn't automatically protect their children when their children get together with other unvaccinated children," Robert M. Jacobson, MD, a pediatrician and vaccine researcher at Mayo Clinic Children's Center told The Washington Post. "I think there we still have to abide by the same rules as before we had the vaccine."

Wearing a mask in public, washing hands, and avoiding large crowds or indoor spaces are other ways to protect your family during a pandemic. The Washington Post said the need for precautions is necessary since vaccines aren't 100% effective. Different viral variants — more transmissible and deadly — have also emerged in various parts of the world.

Vaccinating children is necessary to ending the pandemic

Without vaccinated children, there may be no end in sight to the COVID-19 pandemic. Children are crucial to reaching herd immunity. "We're going to head more towards a community immunity and then obviously on to herd immunity by taking this population out of the potential transmission of COVID-19," Steve Plimpton, MD, an OBGYN in Arizona and principal investigator for the Moderna children's trial in Phoenix, told NPR.

According to the Association of American Medical Colleges, children under the age of 19 make up about one-fifth of the U.S. population, with 3.7 million babies born each year — an increasing group of people at risk for getting sick. By vaccinating children, the virus loses the opportunity to be transmitted to parents, teachers, friends, and more. Like measles and polio vaccines given to infants, there's hope that early vaccinations may produce more robust immune responses in children that last for years.

Kids should continue to get other required vaccinations

COVID-19 isn't the only disease out there. Children keep their immune systems strong by getting other required immunizations. A June 2020 article in The BMJ reported that messaging surrounding routine vaccination has been lost in the pandemic. They reported in one survey that 60% of families considered canceling or delaying their child's routine immunization. As a result, children may become indirect victims of the COVID-19 pandemic because of low routine immunizations. 

An October 2020 study in The Lancet Global Health suggests missing childhood vaccinations may be more dangerous than the coronavirus. They found that in Africa, for every one death from COVID-19 infection, there were 84 deaths in children preventable through routine immunization.

According to the Centers for Disease Control and Prevention, children and babies should remain up to date on routine vaccinations to prevent 16 other severe diseases. Delaying or canceling immunization visits can lead to other health crises such as a measles outbreak, warns the World Health Organization.

Children can become severely ill without vaccination

Children still have a risk of becoming sick from COVID-19 infection. The American Academy of Pediatrics reports that as of April 1, 2021, children make up 13.4% of all COVID-19 cases in the United States. Most children tend to experience milder symptoms or show none at all. But children with a pre-existing medical condition and infants younger than one year old have an elevated risk of developing a severe illness, says the Centers for Disease Control and Prevention.

A March 2021 article in The BMJ reports that children with fevers and abdominal pain may be showing symptoms of a rare but serious COVID-19 complication called multisystem inflammatory syndrome (MIS–C). However, a recent April 2021 study in JAMA Pediatrics found that kids with mild symptoms could still develop MIS­–C weeks after becoming infected.

"It means primary-care pediatricians need to have a high index of suspicion for this because COVID is so prevalent in the society and children often have asymptomatic disease as their initial COVID infection," Jennifer Blumenthal, MD, a pediatric intensivist and pediatric infectious disease specialist at Boston Children's Hospital, told The New York Times.

Immunization may help avoid neurological symptoms

More research is finding a link between pediatric COVID-19 infections that look similar to Kawasaki disease. This disease causes inflammation of blood vessels and tends to affect children younger than five years old, explains the Center for Disease Control and Prevention. Kawasaki disease can cause swelling and irritation in the eyes, mouth, lips, and throat. It can also develop into more severe complications, including coronary artery dilations and aneurysms.

A July 2020 study in Pediatric Rheumatology reported 5.1% of patients with Kawasaki disease tended to have neurological symptoms, including headaches, convulsions, and facial palsy. And a November 2020 study found that 34% of children who developed multisystem inflammatory syndrome (MIS–C) from COVID-19 infection also manifested neurological symptoms similar to Kawasaki disease shock syndrome. Further evidence was found in a December 2020 study reporting a strong link between children worldwide developing neurological symptoms and having COVID-19 infection.

Getting a COVID-19 vaccine could prevent multisystem inflammatory syndrome

Multisystem inflammatory syndrome (MIS–C) is a deadly condition causing swelling in various organs in the body, explains the Centers for Disease Control and Prevention. A September 2020 review published in EClinicalMedicine reported that 71% of children with MIS–C symptoms required hospitalization, and 11% had died. While the exact cause of MIS­–C remains unknown, there has been a link with COVID-19 infection in children.

A March 2021 study in The Lancet Child & Adolescent Health found children who developed MIS–C after COVID-19 infection were more likely to be 6-12 years old and 13-20 years old compared to patients under the age of five. MIS–C was also more likely in Black patients than white patients. Signs of MIS–C that require immediate medical attention include a fever over 100.4 degrees Fahrenheit that lasts for more than a day, says John Hopkins Medicine. Severe complications can erupt, including the risk for long-term brain damage. A March 2021 study in JAMA Neurology found about 22% of adolescents under 21 experienced neurological symptoms because of COVID-19 induced MIS–C.

Vaccinations could improve mental health

Mental health has declined because of the pandemic and repeated lockdowns. An August 2020 study in American Psychologist reported increases in anxiety and depression — and children aren't excluded. Another study that same month found the stress of lockdowns and hospitalizations also negatively affects a child's psychological and emotional state.

The Centers for Disease Control and Prevention advises limiting news coverage of the pandemic to avoid stressing out children and directly answer any questions they may have during this unprecedented time. They also say parents can support their children by maintaining regular routines such as bedtimes and school and allowing them to engage in meaningful activities.

Getting vaccinated may help return a sense of normalcy and improve mental health by having children return to school and hang out with friends. "Vaccination will just be one more step in helping people, especially parents, feel more comfortable with sending kids back to school," Camille Sabella, MD, a pediatric infectious disease specialist, told the Cleveland Clinic. "It's important for kids to do the things that they like doing. It's good for their physical and mental health. However, we still need to take all of the precautions that are in place."

Vaccinations would prevent deaths in children of color

COVID-19 can infect anyone, but the risk has been higher amongst children of Black and Latino descent. An August 2020 study found Hispanic children were most likely to end up hospitalized for COVID-19 infection.

The risk of death is also high in children of color. According to a September 2020 study in The CDC's Morbidity and Mortality Weekly Report, the number of coronavirus deaths in children is small. However, of the children that did pass away from COVID-19 infection, about 75% were children of color.

The Mayo Clinic explains the health disparities amongst people of color aren't due to a biological or genetic weakness towards the coronavirus. Instead, having underlying health conditions and people of color being more likely to have essential jobs increase a person's risk of severe infection. This suggests children of color are more likely to be exposed to COVID-19 from their families. "It really is a reflection of what's going on with the adults in the community because most of the pediatric transmission occurs in their household," Shea Osburn, an assistant medical director for Valley Children's Hospital, told ABC30.

Children with medical conditions are still at risk of developing severe COVID-19 infection

Extra caution should be taken for children with preexisting conditions, advises John Hopkins Medicine. A June 2020 study in JAMA Pediatrics found more than 80% of 48 pediatric cases in the study were hospitalized for severe COVID-19 infection.

John Hopkins Medicine says children living with obesity and chronic lung disease are at risk for severe COVID-19 infections. While there's no concrete evidence linking asthma to a more severe illness, John Hopkins Medicine says it shouldn't be ruled out. They say parents should keep asthma medication in stock and avoid any triggers for an asthma attack.

Children with poorly managed diabetes can become immunosuppressed and increase their risk of severe infection. Indeed, research recently presented at the ENDO 2021 medical conference found children with type 1 diabetes had a 10 times higher risk of experiencing COVID-19 complications and death when their blood sugar was not well-regulated.

Babies can still develop severe COVID infections

Babies are tiny humans that need all the help they can get — and that includes shielding them from potential infection. The Centers for Disease Control and Prevention reports a higher risk of severe COVID-19 illness in babies under the age of 1. Indeed, one study found 10.6% of babies less than 1 years old had severe COVID-19 illness.

The Mayo Clinic says there are several reasons behind the increased severity of the disease. Newborn babies have underdeveloped immune systems and smaller lungs. This makes it easier to develop breathing problems with respiratory viruses such as the coronavirus. COVID-19 testing is also more difficult for infants. They may be discharged from the hospital while positive for the virus and asymptomatic. Medical News Today says babies can develop several complications such as sepsis, organ failure, heart failure, and more. They recommend watching your baby for rapid breathing, grunting, sounds similar to snoring, and nostril flaring.