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COVID-19 vaccine fact sheet for children under five years old

Questions and answers provided by the Children’s Health Coalition

Holland Bloorview bandages

Overview: Getting it, dosing, side-effects, effectiveness

1. I have a child between the age of six months and five years old. Should they get the vaccine?

“Yes!” says Dr. Anne Pham-Huy. She’s an infectious diseases physician at CHEO and a member of the National Advisory Committee on Immunization. “If I had a child under five years old, there’s no doubt I would make sure they got their vaccine. I’d expect them to catch COVID at some point, but I’d rather not have them go through it without any kind of protection.”   Available vaccines are very effective in preventing symptomatic COVID-19 (see question 2 below for more details).  

2. How effective are vaccines for children under five?

In clinical trials for the under five population, the vaccines have been shown to be effective in preventing symptomatic COVID-19. In one study, compared to children that were not vaccinated, the Moderna vaccine reduced the risk of contracting symptomatic COVID-19:

  • Children aged 6-23 months who received the vaccine were at 51 per cent lower risk
  • Children aged 2-5 years who received the vaccine were at 37 per cent lower risk

More generally, COVID-19 vaccines have been show to be very effective at reducing hospitalization, serious disease and death. 
 

3. How many vaccine doses does a child aged six months to five years need? How long should they wait between doses?

For this age group, the Moderna vaccine has two doses and the Pfizer vaccine has three. It takes all doses for a child to be considered fully vaccinated. Having all doses helps the vaccine work as best it can. 

  • For Moderna: The National Advisory Committee on Immunization (NACI) recommends that children under the age of five wait at least eight weeks before getting their second dose. 
  • For Pfizer:  As of September 2022, NACI has not provided a dosing interval recommendation for children under five years of age.

Contact your family doctor or primary care provider to discuss any questions or special considerations such as being immunocompromised.  You can also reach out to the SickKids COVID-19 vaccine consult service. This service provides a safe, judgment-free space for Ontario residents to discuss the COVID-19 vaccine with a pediatric nurse.  Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558.  The service is available in multiple languages, using over-the-phone language interpretation.
 

4. What are the side-effects of the vaccine in children aged six months to five years? What about myocarditis (heart inflammation)?

In the Moderna trial, the majority of children had no side-effects, and any of the side-effects that were observed were mild or typically went away after a few days.
Side-effects may include:

  • feeling tired
  • chills
  • muscle aches or pains; a sore or red arm.

No serious side-effects, like myocarditis (heart inflammation), or other safety concerns were identified. Health Canada will continue to closely monitor this vaccine for serious side-effects and will take action if any safety concerns are identified. 

Contact your family doctor or primary care provider if you have concerns or if your child has had a negative reaction to a previous vaccine.  You can also reach out to the SickKids COVID-19 vaccine consult service.  Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558. The service is available in multiple languages, using over-the-phone language interpretation.
 

5. If my child had COVID-19, should they still get vaccinated? How long should they wait?

Yes, kids (and adults) should still get the vaccine, even if they had COVID-19. This is because:

  • We do not know how long antibodies against COVID-19 stay in the body after infection 
  • People can get COVID-19 again (and sometimes be even more sick)
  • The vaccine can help support a person's antibodies to fight against COVID-19
  • The clinical trials found that the vaccine was safe for people who previously had COVID-19. 

The National Advisory Committee on Immunization suggests children in this age group wait eight weeks after getting COVID-19 before they have their first or second dose. For children who are moderately to severely immunocompromised, they may wait four to eight weeks after getting COVID-19 before they get their first or second dose.
 

Vaccine options: Should I wait? 

6. Can I pick which COVID-19 vaccine my child gets?

There are two approved vaccines for children, Moderna and Pfizer. As of September 2022, only the Moderna vaccine is generally available in Ontario.  

7. Should I wait for the Pfizer vaccine to be available for children under five?

No. There is no reason to wait. We encourage you to get the first vaccine that is available. 

8. My child is four years old now and turning five soon. Are the doses different by age? Should I wait for them to turn older to get their vaccine?

The first COVID-19 vaccine (regardless of brand) that is available for your child will be the best vaccine to get, as it will provide protection against COVID-19 to your child as soon as possible. Vaccine doses are based on age and the maturity of the immune system and not size or weight of your child. 

Breastfeeding and other routine vaccinations: Recommendations

9. I’m breastfeeding my child. What should I consider?

All available COVID-19 vaccines approved in Canada can be used while breastfeeding. Presently, the Pfizer and Moderna vaccines are preferred because they have the most data available on safety and effectiveness during pregnancy. 

Vaccinated people can pass antibodies to their baby through pregnancy and breastmilk, which can protect infants until at least six months of age. Providing a COVID-19 vaccine to a child over 6 months old is the best way to protect them against COVID-19.
 

10. Can I get my child’s routine vaccinations at the same time as their COVID-19 vaccination?

For anyone over five years of age, the National Advisory Committee on Immunization recommends that COVID-19 vaccines may be given at the same time with any other non-COVID-19 vaccine. In younger children, they suggest waiting 14 days between a child’s COVID-19 vaccine and other routine vaccinations.  

11. My child is behind on routine vaccinations. Should they get the COVID-19 vaccination first and then get up to date on their routine vaccinations?

Both routine (including for mumps, measles, rubella, chickenpox, polio, diphtheria) and COVID-19 vaccinations are important and should be taken as soon as possible.  If your community is experiencing an increase of COVID-19 cases, you may decide to have your child get their COVID-19 vaccines first, based on the personal risk factors for your child and your family.  

Additional resources: Support for you and your child

12. I cannot decide if vaccinating my child is the right thing to do. Who can I talk to?

Contact your family doctor or primary care provider to discuss your concerns.  You can also reach out to the SickKids COVID-19 vaccine consult service. This service provides a safe, judgment-free space for Ontario residents to discuss the COVID-19 vaccine with a pediatric nurse.  Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558.  The service is available in multiple languages, using over-the-phone language interpretation. 

13. Do you have any helpful tools or additional resources I can use to support my child’s vaccination?

Some parents and caregivers have found that a “social story” (visual depiction) can be helpful to reduce anxiety and aid in explaining the entire vaccination process to children. Here’s an example from Holland Bloorview.

CHEO also has a resource on how to distract your child during medical procedures. 

SickKids also has a resource to help kids cope before and during vaccination and needle procedures.

McMaster Children’s Hospital has a video on supporting children for vaccination.

Other resources that may be helpful: 

14. Where can I get my child vaccinated? Where can I get more information?

In Ontario, you can get book a vaccine through the provincial booking site.

You can reach out to the SickKids COVID-19 Vaccine Consult Service which is a by-appointment phone service that provides a safe, judgment-free space to have an open conversation about the COVID-19 vaccine. The consult service provides expert guidance for children, youth and those who are pregnant, breastfeeding, or planning to conceive. It is available in multiple languages, using over-the-phone language interpretation. Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558. 

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