COVID-19 vaccines for children ages 6 months and older

COVID-19 vaccines protect people from getting COVID-19. These vaccines "teach" your child's body how to defend against the SARS-CoV-2 virus, which causes COVID-19.

WHY CHILDREN AND TEENS SHOULD GET VACCINATED

It's true that most children and teens are at lower risk from becoming very sick from COVID-19. But low risk does not mean no risk. Children and teens can:

• Become infected with COVID-19
• Become seriously ill from COVID-19 and need to be hospitalized
• Have serious short- and long-term effects or complications from COVID-19
• Die from COVID-19, although this is very rare
• Spread COVID-19 to others, including those at risk for serious illness, such as grandparents

Children with underlying medical conditions are more at risk for severe illness from COVID-19. So, vaccination is very important to help protect against the virus.

There are many good reasons to have your child or teen get a COVID-19 vaccination:

• It will protect other people in the family at risk for serious illness from COVID-19.
• It will protect your child from serious illness if they do get COVID-19.
• It is a safer way to build protection than from getting COVID-19.

ABOUT COVID-19 VACCINES FOR CHILDREN AND TEENS

Children ages 6 months to 17 years can get either the Pfizer-BioNTech or Moderna mRNA vaccine.

• COVID-19 mRNA vaccines use messenger RNA (mRNA) to tell cells in the body how to briefly create a harmless piece of "spike" protein that is unique to the SARS-CoV-2 virus. Cells then get rid of the mRNA.
• This "spike" protein triggers an immune response inside the body, making antibodies that protect against COVID-19. Your child's immune system then learns to attack the SARS-CoV-2 virus if they are ever exposed to it.
• There are two mRNA COVID-19 vaccines currently approved for use in the United States, the Pfizer-BioNTech and the Moderna COVID-19 vaccines.
  

The COVID-19 vaccine given to children and teens has the same active ingredients as the vaccine given to adults. Dosage is based on the child's age on the day of vaccination. It is not based on the child's size or weight.

The original mRNA vaccines, also called monovalent vaccines, are no longer available. The updated mRNA vaccines, also called bivalent vaccines, are currently in use. These updated (bivalent) vaccines protect against the original COVID-19 virus and certain variants of the COVID-19 virus.

VACCINATION SCHEDULE

Your child's vaccination schedule is based on age and vaccination history.

Children who DID NOT get the original vaccine can have the following shots.

• Children ages 6 months to 4 years can receive 3 doses of the updated Pfizer-BioNTech vaccine or 2 doses of the updated Moderna vaccine.
• Children age 5 years can receive 1 dose of the updated Pfizer-BioNTech vaccine or 2 doses of the updated Moderna vaccine.
• Children ages 6 years and older should get 1 dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine.

Children who DID get the original vaccine can have the following shots:

• Children ages 6 months to 4 years who got 2 or 3 doses of the original Pfizer-BioNTech vaccine should get 1 dose of the updated Pfizer-BioNTech COVID-19 vaccine.
• Children ages 6 months to 4 years who got 1 dose of the original Pfizer-BioNTech vaccine, should get 2 doses of the updated Pfizer-BioNTech COVID-19 vaccine.
• Children ages 6 months to 4 years who got 1 or 2 doses of the original Moderna vaccine, should get 1 dose of the updated Moderna COVID-19 vaccine.
• Children age 5 years who got 1 or more doses of the original Pfizer-BioNTech or Moderna vaccine, should get 1 dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine.
• Children ages 6 years and older should get 1 dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine regardless of which original vaccine they received.

OTHER VACCINES

Children ages 12 years and older who are unable or who choose not to get an updated Pfizer-BioNTech or Moderna COVID-19 vaccine can get the Novavax vaccine.

• The Novavax vaccine is given as an injection (shot) in the arm in 2 doses, given 3 to 8 weeks apart. This is called the primary series.
• Some people ages 12 to 39 years may receive the second shot 8 weeks after the first shot (especially males). This may help reduce the very rare risk of myocarditis and pericarditis (inflammation of the heart muscle or lining).
• You may get 1 additional booster dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine 2 months after completing the primary series.

VACCINE MYTHS

COVID-19 vaccines:

• DO NOT contain any live virus, and they cannot give children COVID-19
• DO NOT affect or interfere with children's genes (DNA)
• DO NOT affect or interfere with fertility or future fertility in children

To get up-to-date accurate information about COVID-19 vaccines, go to the Centers for Disease Control and Prevention (CDC) website:

• Vaccines for COVID-19 - www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
• Myths and facts about COVID-19 vaccines - www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html

VACCINE SIDE EFFECTS

While COVID-19 vaccines will not make children sick, they may cause certain side effects and flu-like symptoms. This is normal. These symptoms are a sign that your child’s body is making antibodies against the virus. Common side effects include:

• Pain, redness, or swelling on the arm (or leg up to age 3) where they got the shot
• Tiredness
• Headache
• Muscle pain
• Chills
• Fever
• Loss of appetite
• Swollen lymph nodes

Side effects from the shot may affect your child's ability to do daily activities, but they will go away in a few days. Even if your child has side effects, they should get the second shot. Any side effects from the vaccine are far less dangerous than the potential for serious illness or death from COVID-19.

HOW TO GET THE VACCINE

COVID-19 vaccines are available to all children living in the United States at no cost. Children can get this free shot regardless of their immigration or health insurance status.

There are several ways to find vaccination providers near you.

• Ask your child's health care provider if they offer COVID-19 vaccines for children and teens.
• Check your local pharmacy's website or call them to see if they offer vaccines for children and teens.
• Contact your local health department.
• Go to the CDC VaccineFinder.
• Text your zip code to 438829 or call 1-800-232-0233 to find vaccine locations near you.

VACCINE SAFETY

The safety of vaccines is the top priority, and COVID-19 vaccines for children have passed rigorous safety standards before approval. They continue to be closely monitored to ensure they are safe and effective.

Serious health events from COVID-19 vaccines, such as an allergic reaction, are rare.

Rare cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the outer lining of the heart) have been reported in children and teens ages 5 years and older after getting the Pfizer-BioNTech and Moderna vaccine.

• This reaction has tended to occur more often in male adolescents and young adults ages 12 to 39 years.
• It occurs more often after the second dose, usually a few days after vaccination. Studies show that this rare risk may be reduced with a longer time between the first and second dose.
• With proper care and rest, most people who had the reaction got better quickly.
• For people who had this rare reaction, it is important to talk with a cardiologist (heart doctor) about how and when to return to exercise and sports.

Symptoms of myocarditis and pericarditis include:

• Chest pain
• Shortness of breath
• Fast-beating heart, fluttering, or pounding heart

If your child or teenager has any of these symptoms, get medical help right away.

To learn more about COVID-19 vaccine safety, go to the CDC website:

• Ensuring COVID-19 Vaccine Safety in the United States -- www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html
• V-Safe After Vaccination Health Checker -- www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html

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Centers for Disease Control and Prevention website. Stay up to date with covid-19 vaccines including boosters. www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Updated June 7, 2023. Accessed June 7, 2023.

Centers for Disease Control and Prevention website. Myocarditis and pericarditis after mRNA COVID-19 vaccination. www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html. Updated September 27, 2022. Accessed June 7, 2023.

Centers for Disease Control and Prevention website. Myths and facts about COVID-19 vaccines. www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html. Updated February 16, 2023. Accessed June 7, 2023.

Fleming-Dutra KE, Wallace M, Moulia DL, et al. Interim Recommendations of the Advisory Committee on Immunization Practices for Use of Moderna and Pfizer-BioNTech COVID-19 Vaccines in Children Aged 6 Months-5 Years - United States, June 2022. MMWR Morb Mortal Wkly Rep. 2022;71:859-868. www.cdc.gov/mmwr/volumes/71/wr/mm7126e2.htm.

Fowlkes AL, Yoon SK, Lutrick K, et al. Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR Morb Mortal Wkly Rep. 2022;71(11):422-428. PMID: 35298453 pubmed.ncbi.nlm.nih.gov/35298453/.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 06/07/2023.