Helping your child with the COVID-19 vaccine

UCLA Health's Dr. Juan C. Alejos and Dr. Carlos Lerner offer advice for parents.

Now that children ages 5-11 are eligible to receive the COVID-19 vaccine, the smaller doses, delivered through smaller needles, are expected to have an outsize effect in helping families return to normal life.

UCLA Health pediatric experts said parents play an important role in helping younger children prepare for the two-dose Pfizer series, as well as monitoring them for any rare side effects.

Juan C. Alejos, MD, a pediatric cardiologist and medical director of the Pediatric Heart Transplant/Cardiomyopathy Program, and Carlos Lerner, MD, a pediatrician and professor of pediatrics at the David Geffen School of Medicine at UCLA, answered questions about what to expect with the new rollout.

Are there any advantages to getting vaccinated at a pediatrician’s office rather than a pharmacy or school vaccination event?

“For a majority of kids, I don’t see any advantage to that,” Dr. Alejos said. “For children who have underlying health conditions, I think it’s totally reasonable if they want to have it done at their pediatrician’s office or a hospital setting, if the parents are at all concerned.”

Dr. Lerner said, “It’s a very safe vaccine and the immediate serious reactions to the vaccine are extremely rare. I think anywhere they can get it is fine. In most cases, whatever option is most convenient is really a good choice for the parents.”

Dr. Juan C. Alejos

How do you recommend that parents talk to kids about the vaccine and why they’re getting it?

“I think they need to be honest with them,” Dr. Alejos said. “Tell them this is a lot like the other vaccines you get from the doctor. It’s designed to protect you from a condition that can make you miss school and keep you from spending time with your friends and family.”

What are some ways to reduce anxiety that children may be feeling?

“You may want to come up with a plan with your child for how they’re going to get the vaccine,” Dr. Lerner said. “Talk through it, whether it’s reading a story or sharing your past experience, and then deciding what to do during the visit that may help your child. For some younger kids, it may be looking at a video on the phone as they receive the vaccine.”

Is it helpful for parents to share their own experience with the vaccine?

“I think it’s a great idea in terms of reducing fear,” Dr. Lerner said. “Kids understand those kind of concrete examples better than some general comments.”

Can kids expect similar side effects to their parents or older siblings?

Dr. Carlos Lerner

“The majority of kids are going to have pain or soreness at the injection site, which has been fairly common,” Dr. Alejos said. “For more symptoms, it’s going to be very hit and miss. There are a lot of people who had absolutely no symptoms from both vaccines and some had fever and malaise for a few days following the vaccine.”

Dr. Lerner said, “At this point it looks like the side effects in the younger kids are potentially milder than they were for the adolescents and young adults.”

Should families plan timing of the shot around school and extracurricular activities in case of side effects?

“If there’s a really important event happening within a day or so of the vaccine that’s something to take into account,” Dr. Lerner said. “For the majority of kids, it is not likely to interfere with school for the next day, although it’s a possibility that it might.”

How should side effects be treated?

“Tylenol or ibuprofen are our best bets,” Dr. Lerner said. “Staying hydrated, adjusting their activities so they can rest if needed. Having an ice pack for the sore arm sometimes can be helpful as well.”

If a child develops a fever or other side effects, is it OK to go to school?

“If they have a fever our recommendation would be not to send them to school,” Dr. Lerner said. “Schools have made it very clear that if a child has a fever they shouldn’t be at school. You do want to monitor them until that fever resolves for them to return to school, and contact your child’s doctor if the symptoms persist.”

What’s the risk after vaccination of myocarditis, a rare side effect that causes inflammation of the heart muscle?

“I’ve had quite a few emails already about that,” Dr. Alejos said. “The numbers are tiny compared to the number of people that have been immunized. The majority of those patients have symptoms that last a day or two and self-resolve. They don’t require any hospitalization or medication and there are no further issues that come with that. You cannot state that it is not going to happen, but for the parents, I tell them that the consequences of developing COVID that we’ve seen with the Delta variant are much higher than the risk of myocarditis. The benefits heavily outweigh the risk of the vaccine.”

What are the symptoms and what should parents do if they occur?

“They can have some chest pain and feeling of palpitations or their heart fluttering in their chest. Shortness of breath,” Dr. Alejos said. “I think that it is reasonable to call their pediatrician.”

Is it OK to get the flu shot or other vaccines at the same time?

“Yes, they can be given at the same time,” Dr. Lerner said. “One does not affect the other.”

Will the smaller needle used for the pediatric dose be less painful?

“I think it’s supposed to be less intimidating and less painful when the injection is given,” Dr. Alejos said. “It’s really not the needle that’s causing the pain or soreness. The soreness comes from what’s injected. I think the needle will be a little bit more reassuring for the kids, but I don’t think it will change the arm soreness.”

Dr. Lerner said, “I think the main reason they are delivered in a different way is to avoid confusion by the people administering the vaccine so they give the right dose. It’s possible it may reduce the discomfort a little.”

What advice do you have for kids who hate needles?

“It’s not easy,” Dr. Alejos said. “The anxiety will be worse for them but it will be over before they really have a chance to feel the pain.”

Should kids who have already had COVID-19 get vaccinated?

“Yes. That’s true for both kids and adults,” Dr. Lerner said. “Although we don’t know for sure in kids, we do know in adults there’s increasing evidence that vaccination provides better protection than having had COVID and longer-lasting protection.”

For kids who will be turning 12 soon, is it better to wait in order to receive the larger dose?

“I don’t think there’s any more benefit to waiting versus just getting it now,” Dr. Alejos said. “At that transition, it’s kind of a blurred line. There’s really nothing magical about 11 years or 12 years, it’s just the way the studies were done. I think either dose is going to be sufficient.”

If kids get their shots now, will they have partial protection for Thanksgiving gatherings?

“Yes. It’s not full immunity but it’s still providing some degree of immunity so I think it will be helpful,” Dr. Alejos said. “If you start now, you can be fully immunized by Christmas.”

What questions have you been getting from parents?

“Mostly about is it worth it? Is it safe? Should I do it?” Dr. Lerner said. “I think most parents recognize that COVID is less serious in kids because we’ve been telling them that all along. I say, ‘I did it for my kids. My kids are a little older, but that gives you a sense of what I think of the vaccine.’ We also have the experience of millions of doses given to older kids, 12 to 17. Serious side effects have been very rare.”

Dr. Alejos said, “I’ve had a couple ask should they take all their normal medication, which the answer is yes.”

Have you gotten questions from kids about the vaccine?

“I’ve gotten questions from a couple of kids asking if they can get it and when they can get it,” Dr. Alejos said. “I think they’re tired of going to school with a mask on, they’re tired of not being able to see their grandparents because they’re not vaccinated. The only way we’re going to get back to a ‘normal lifestyle,’ like getting rid of masks and the constant worry of exposure, is for as many of us to get immunized as possible.”

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Courtney Perkes is the author of this article.