How pediatricians are handling questions about COVID vaccines for kids age 5-11

Since the Pfizer COVID-19 vaccine received emergency use authorization from the FDA for children ages 5 and up, some parents and caregivers have raised concerns and asked questions about the safety, effectiveness and necessity of vaccinating their kids. Below, two prominent osteopathic pediatricians share how they’ve approached working with vaccine-hesitant parents and how the child vaccination effort is going so far at their practices.

Dr. Ronald Marino, DO, director of the Center for School Health at Mt. Sinai South Nassau Hospital in Oceanside, New York, and clinical professor of pediatrics at the Mt. Sinai Medical School in New York City, strongly recommends that all his patients aged 5 and older get vaccinated against COVID.

“It’s for their own wellbeing, as well as that of their family and community,” he says.

Dr. Tyree Winters, DO, program director of the pediatric residency at Goryeb Children’s Hospital in Morristown, New Jersey, has seen a strong start to the vaccination effort, with 500 appointments filled up on the first day the vaccine was available for children younger than 12. Luckily, his hospital was prepared for high demand, and was planning for it before receiving the green light. So, they were able to quickly roll them out.

“We understand that it’s new, but we pediatricians are there to give open and frank conversations about any questions, and show we’re there for our patients,” says Dr. Winters.

The AOA encourages the use of COVID-19 vaccines.

Side effects are similar to that of adults

For some, a big concern lies around side effects – with the vaccines still being relatively new, parents are concerned about how their children’s bodies may react, and how the side effects might be different from their own as adults. Dr. Marino is sympathetic, but says that so far, evidence indicates that the reactions are similar to adults’.

For children ages 5-11 who received the Pfizer vaccine in its clinical trial, 34% felt fatigue after the first dose, and 39% felt fatigue after a second dose, according to FDA information reported by Business Insider. About 22% of that group experienced a headache after receiving the first dose, and 28% had a headache after the second dose.

Other symptoms included:

Muscle pain: First dose, 9%; second dose, 12%

Diarrhea: First dose, 6%; second dose, 5%

Chills: First dose, 5%; second dose, 10%

“They’re mild and self-limited,” says Dr. Marino. “Parents are concerned about myocarditis. That is a rare, generally self-limited complication, and the risk of developing myocarditis associated with COVID infection outweighs the risk of the vaccine.”

Myocarditis, or inflammation of the heart muscle, occurred in 54 cases per million doses administered to males ages 12–17 years in the week following vaccination, according to a study cited by the CDC.

Some parents are reassured when they learn that the dose for those age 5-11 is smaller, just one-third of the adult dose, according to Dr. Winters.

The DOs see the biggest barrier as making sure that everyone understands that the vaccine will make a difference. A continuing study done by the American Academy of Pediatrics (AAP) found that as of November 2021, close to 6.8 million children have tested positive for COVID, and the rates remain high, with 15 straight weeks of the data showing new child COVID cases above 100,000. Although data indicate that only around 1% required hospitalization for the illness, it’s unclear what longer-term impacts these children will experience, and the DOs believe the vaccine will do its job to combat the virus.

“There’s a big concern on fertility and if the vaccine will affect future fertility for patients, and parents wondering if it has been around long enough to know the lasting side effects,” says Dr. Winters. “Even when the parents are vaccinated, some are hesitant with vaccinating their children. We’ve been trying to express understanding of their concerns and validate them, making sure they feel heard.”

The data we have so far shows that children are not experiencing long-term effects from the vaccine, Dr. Winters says.

The CDC has also weighed in on COVID vaccines and fertility, stating “there is currently no evidence that antibodies made following COVID-19 vaccination or that vaccine ingredients would cause any problems with becoming pregnant now or in the future.”

Torn between decisions

With children still in the early stages of getting vaccinated, Dr. Marino has so far seen a three-way split trend between his patients’ parents – one-third want their kids to get the shot right away, while one-third plan to get it but still want to wait, and the final third are staying firm in never vaccinating their children against COVID. The DOs are working hard to understand each family’s situation, but stand by their recommendation to get the vaccine, believing that it’s what’s best for the community as a whole, especially when there’s still a possibility that children can contract COVID.

“The studies suggest that the vaccine is effective in preventing disease,” says Dr. Marino. “Although it won’t completely prevent asymptomatic cases, those who are vaccinated and test positive for COVID will likely experience a less harmful case than those who remain unvaccinated.”

Demand for COVID vaccines for kids, and continuing use of masks

For the parents who have strongly and confidently decided “yes” to give their child the COVID vaccine, the demand is strong, but will likely fall off once the children from this group have reached full immunization. Since the total number of people in the country who are vaccinated, including children, likely won’t ever reach 100%, Drs. Marino and Winters still encourage mask wearing and social distancing right now, especially in areas where schools or public spaces might require it.

“At this time, the CDC is recommending that masks continue to be worn in schools,” says Dr. Marino. “The percentage of vaccinated teachers and students will be a factor in making these decisions. It is difficult to have separate policies for vaccinated and unvaccinated people. This is a very emotional and political mandate and has led to some very tense stand-offs at school board meetings.”

Dr. Winters agrees, noting that everyone should still take precautions when feeling ill, or after having been exposed to COVID.

“You’ll want to make sure you’re making everyone aware of any potential exposure,” says Dr. Winters. “But we’re excited to see a 92% efficacy so far.”

Looking ahead

Both DOs say they will continue to encourage their patients parents to get their children vaccinated, adjusting by age when the vaccine is authorized for even younger kids, and are keeping the goal in mind of keeping their community as healthy as possible.

“We are all tired and want this behind us, but we must maintain vigilance and get immunized to do that,” says Dr. Marino. “Otherwise, the potential for new variants is too great, and this pandemic will smolder, and maybe even get worse.”

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