Since the Food & Drug Administration (FDA) gave the green light to the COVID-19 vaccine for babies, toddlers and preschoolers, many parents of the youngest children have opted to vaccinate their little ones. Others, however, have held off, citing concerns about the shots' safety.
But doctors and other experts say it's incredibly important to vaccinate your little one against COVID-19, and assure hesitant parents that the shots available are perfectly safe and effective with minimal-to-no side effects.
And with COVID-19 hospitalizations rising among children once again, it's important to make sure your child is up-to-date on their immunizations.
"The vaccine seems to be very protective against getting very ill from COVID," Dr. Posner says. Among kids who do contract the virus, she says, it can reduce the risk of serious complications that require a trip to the hospital.
Two million children under age 5 have gotten the vaccine, according to the Centers for Disease Control's (CDC's) latest statistics.[1]
Here’s a look at everything we know about the COVID-19 vaccines for young children, plus why it’s so important for eligible kids of all ages to be vaccinated against the virus.
Can babies and children get the COVID-19 vaccine?
Yes. Currently, the Pfizer-BioNTech vaccine (marketed as Comirnaty) has full approval from the FDA for those 16 and older and is authorized for emergency use in those 6 months and up. The Moderna vaccine (marketed as Spikevax) has full FDA approval for people 18 and up and is authorized for emergency use in those 6 months and up.
The updated versions of the vaccine, which better targets the latest circulating strain or strains, were made available in September 2023 for everyone, including children aged 6 months and older. All kids ages 6 months and up should receive an updated version of the vaccine to stay protected this fall and winter, the CDC urges.[2]
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The COVID-19 vaccine is still free for most kids in the U.S., and most health insurance plans will cover the vaccine at no cost to you, according to the CDC.
If you don't have insurance or your plan doesn't cover the vaccine, you can get a free shot from a local health center; state, local, tribal, or territorial health department; or a pharmacy participating in the CDC’s Bridge Access Program. (Any other kids you have can get a free shot from a local provider enrolled in the Vaccines for Children program.)
How long should my child wait between doses of the COVID-19 vaccine?
Babies and toddlers can get either vaccine (Moderna or Pfizer-BioNTech), depending on availability in their area and their families' preference, the CDC says.
Dosing schedules for children ages 6 months through 4 years will differ based on the type of vaccine your child gets, along with whether she has already gotten a COVID-19 shot in the past.
For children who have previously been vaccinated against COVID-19, the CDC recommends:
The Pfizer-BioNTech vaccine: Young children 6 months to 4 years who have had one previous dose should get a second dose three to eight weeks after the first, and a third dose at least eight weeks after the second. Children ages 6 months to 4 years who have had two or more previous doses should get an updated vaccine at least eight weeks after their last dose. Children 5 and up should get an updated vaccine (with either the Pfizer or the Moderna shot) at least eight weeks after their second dose.
The Moderna (Spikevax) vaccine: Young children 6 months to 4 years who have had one previous dose should get a second dose four to eight weeks after the first. Children ages 6 months to 4 years who have had two or more previous doses should get an updated vaccine at least eight weeks after their last dose. Children 5 and up should get an updated vaccine (with either the Pfizer or the Moderna shot) at least eight weeks after their second dose.
For children who have not yet been vaccinated against COVID-19, the CDC recommends:
The Pfizer-BioNTech vaccine: Young children 6 months to 4 years should get a second dose three to eight weeks after the first, and a third dose at least eight weeks after the second. Children 5 and older should get one dose.
The Moderna (Spikevax) vaccine: Young children 6 months to 4 years should get a second dose four to eight weeks after the first. Children 5 and older should get one dose.
In October 2023, the FDA also approved an updated version of the Novavax for the 2023-2024 season for emergency use for children and adults ages 12 and up.
Unlike the Pfizer and Moderna vaccines, which are mRNA vaccines, the Novavax vaccine is a subunit protein vaccine. Subunit protein vaccines contain antigens that stimulate the immune system to launch a protective response against a virus.
The newest batch of COVID-19 vaccines, released in September 2023, are monovalent, meaning they only target the latest circulating strains. (The boosters released last year, which were bivalent, targeted the original COVID-19 strain and the Omicron strain that was circulating last summer and fall.)
So even if your child hasn't been vaccinated in the past, they'll be well protected, since the original strain of COVID-19 and other earlier variants are no longer in circulation, the AAP says.
Can my child get the COVID-19 shot at the same time as another vaccine?
It’s perfectly fine for your child to get the COVID-19 vaccine at the same time as another routine vaccine (or shortly before or after), including the flu shot, say the CDC and the AAP. There are no increased risks of side effects from getting the COVID vaccine along with another vaccine, including the seasonal flu vaccine.
Should children get the vaccine if they already had COVID-19?
The CDC stresses that everyone eligible for the vaccine should get it, even if they already had COVID-19. Right now, that includes pregnant women and other adults, as well as all children 6 months and older.
It’s true that the body gains some protection from COVID-19 after infection. But experts don’t know for sure how long that protection actually lasts. Getting the vaccine may make you less likely to get COVID-19 again, the CDC adds.
Talk to your pediatrician about how long to wait between a case of COVID-19 in your child and the vaccine, if your little one was unvaccinated or partially vaccinated at the time of infection with the virus. The current recommendation is to wait about 90 days between a case of COVID and the vaccine.
Does my child need a COVID-19 booster shot?
Every child aged 6 months or older should get an updated COVID-19 shot this fall, the CDC recommends. Similar to annual flu shots, the updated vaccine targets the latest circulating strains of COVID-19, offering the best protection against the virus this fall and winter. If your child hasn't yet been vaccinated at all, she should receive additional doses for maximum protection.
Experts referred to the updated shots that came out in September 2022 (which targeted the Omicron variants) as "boosters" that babies, kids and adults should get after receiving their initial vaccine dose(s), to enhance or restore the protection that the original COVID-19 vaccine offered.
Now that experts know more about how the virus seems to change each year, there's been a shift towards treating the COVID-19 vaccines like annual flu shots and avoiding calling these latest vaccines "boosters."
"Each year, there will likely be an updated version of the shot that we'll be encouraged to get each fall to best protect against the current strain," says Rajeev Fernando, M.D., an infectious diseases consultant based in Southampton, New York, and a member of the What to Expect Medical Review Board.
Are the COVID-19 vaccines safe for infants and young children?
Yes. As with all vaccines, the COVID-19 vaccine has gone through a meticulous research and approval process to ensure its safety for both adults and children. In fact, the CDC says the COVID-19 vaccines have had "the most intense safety monitoring in U.S. history."
In a June 2022 news release, the AAP said in a statement that the group "supports [the CDC's] recommendation and encourages pediatricians to promote vaccination and give COVID-19 vaccines."
Safety surveillance of more than 245,000 COVID-19 vaccine doses given over the course of nine months to children under 5 also did not show any adverse events in the 21 days after vaccination, which mirrored clinical trial results of the Pfizer-BioNTech and Moderna vaccines, according to a June 2023 Pediatrics review.
"The AAP has pushed for rigorous studies in children so we know the vaccine is safe, effective and the right dose," says Jen Trachtenberg, M.D., an assistant clinical professor of pediatrics at Icahn School of Medicine at Mount Sinai in New York City and a spokeswoman for the AAP.
There's also no need to worry that the mRNA technology used in the Pfizer-BioNTech and Moderna vaccines will change your child’s DNA. That's because mRNA is unable to enter the nucleus of the cell, where our DNA lives, plus the mRNA is broken down by the body shortly after a person is vaccinated, according to the National Institutes of Health.
Why weren't children included in the first COVID-19 clinical trials?
Children's immune systems are different from those of adults, and their immune responses can vary according to their age, explains Sean O'Leary, M.D., M.P.H., vice chair of the Committee for Infectious Diseases at the AAP and professor of pediatric infectious diseases at the University of Colorado Anschutz Medical Campus/Children’s Hospital Colorado.
While a teenager may respond to a vaccine similarly as an adult, an elementary-school-age child, a toddler, or an infant could have a different reaction. That’s why it's so important to hold clinical trials in kids separately.
The trials in children go through two stages. The first stage looks at different dose levels, explains Dr. Fernando. As a next step, those doses are then tested against placebo injections.
About 24 percent of the U.S. population — around 74 million people — is under 18, and experts say getting kids vaccinated is important in preventing severe illness and hospitalization.
Does the COVID-19 vaccine cause myocarditis in children?
There were no reports of myocarditis — an inflammation of the heart muscle — from either vaccine in the clinical trials for children ages 5 to 11. And the June 2023 Pediatrics review found no reports of myocarditis among children under 5.
A very small number of adolescents and young adults have experienced mild cases of myocarditis after receiving the COVID-19 vaccine. That said, becoming infected with COVID-19 is much more likely to cause myocarditis than receiving the vaccine, according to the AAP.
Myocarditis can occur when the body’s immune system reacts to an infection or another trigger. Symptoms of myocarditis include:
- Abnormal heart rhythms (feelings of a fast-beating, fluttering or pounding heart)
- Shortness of breath
- Chest pain
Post-vaccine cases of myocarditis and pericarditis — an inflammation of the outer lining of the heart — have occurred most often in males, after the second dose and within a week of inoculation. Most patients recovered quickly with rest.
Can the COVID-19 vaccine give my child the virus?
No. The COVID-19 vaccine works much like other routine immunizations that children get. It contains molecules with a set of instructions that teach the immune system to make its own protective antibodies that can fight the germs that cause the virus, says the AAP.
But the vaccines don’t contain the actual virus itself. "There’s a zero chance of someone getting COVID-19 from the COVID-19 vaccine," Dr. Fernando says.
If a child (or adult) feels a little under the weather after being vaccinated, that doesn’t mean she has COVID-19. Instead, she is experiencing normal side effects that can develop as the immune system kicks into high gear to launch a protective response against the virus, the CDC notes.
What side effects might a baby or young child experience after COVID-19 vaccination?
Side effects for both the Pfizer-BioNTech and Moderna shots have been shown to be similar to the types of mild, short-lived side effects your infant, toddler or young child might experience from other immunizations.
Fever and soreness at the injection site were most common; babies and toddlers under 3 years may also be sleepy, irritable or have less of an appetite, while children 3 to 5 years might feel low energy, have a headache or experience flu-like symptoms.
These side effects can be a little inconvenient — fussy, cranky babies and toddlers aren't fun. But experts agree that protection against COVID-19 is worth a day or two of discomfort.
"The problem with COVID is that we just don't know who will get really sick and who will not get sick at all," Dr. Posner says. "I would prefer my child get mild side effects from a vaccine and hopefully get decent protection from severe illness versus taking the chance."
Wondering about the shots' impact on bigger kids? As with adults, the most common side effects in adolescents and older children are a sore arm, fatigue, headache, chills, fever, and muscle and joint pain, particularly after the second dose, the FDA notes. Side effects don’t seem to be stronger or more prevalent in kids, and many haven’t had side effects at all.
As with other vaccines, it’s possible for a child or adult to experience an allergic reaction to the COVID-19 shot. These reactions are extremely rare, but when they do occur, it's usually shortly after immunization. That’s why everyone who gets the vaccine needs to wait 15 to 30 minutes before leaving the facility where they received the shot. If an allergic reaction happens, medication can quickly treat it.
As for longer-term side effects? In general, serious side effects that could cause long-term health problems are extremely rare after any immunization, and the same has been true for the COVID-19 vaccine, the CDC says. If parents have any concerns after their children receive the vaccine, they should check in with their pediatricians.
Are the COVID-19 vaccines effective in infants and young children?
Yes. According to data from Pfizer's clinical trials of the original vaccine, the Pfizer vaccine is 80 percent effective at preventing COVID-19 infection in children 6 months to 4 years of age. Moderna’s vaccine efficacy was 51 percent in clinical trials for those 6 months to under 2 years and 37 percent for children ages 2 to 5.
The vaccines also reduce the risk of hospitalization among babies and young kids. A JAMA study published in September 2023 that looked specifically at the Pfizer-BioNTech vaccine estimated that the immunization reduced hospitalization rates by 33 percent among children ages 6 months to 4 years between July 2022 and May 2023.
The Pfizer-BioNTech vaccine is also effective at preventing severe illness in bigger kids. One study published in the New England Journal of Medicine found that kids ages 5 to 11 who had received two shots of the vaccine were 68 percent less likely to be during the Omicron surge than their unvaccinated peers.
Another CDC report found that COVID-19 hospitalization rates in children ages 5 to 11 years were approximately twice as high as unvaccinated kids compared to vaccinated ones during the original Omicron wave.
Another study published in the New England Journal of Medicine in May 2022 also found that two doses of the Moderna vaccine produced a strong immune response in the 6- to 11-year-old age group.
Why is it so important for children to get the COVID-19 vaccine?
First and foremost, it will protect your child’s health. "The vaccine is the best way of not getting COVID-19," says Dr. Trachtenberg. Vaccines also reduce the chance of serious illness and/or hospitalization for children who do contract the virus, Dr. Posner adds.
It’s true that kids are less likely to get seriously sick compared to adults. But they can still contract the virus and spread it to others, even if they don’t show COVID-19 symptoms.
Millions of children have come down with the virus since the start of the pandemic. In rare instances, kids can develop severe complications that require hospitalization, intensive care or a ventilator, the CDC notes.
And considering the pandemic's effects on their daily lives, vaccination offers more than just physical protection.
"We’ve seen the toll this has taken on kids' mental health," Dr. Trachtenberg says. "We really want children and adolescents to return to normal as much as possible, to be able to do their activities, socialize with friends indoors, and feel confident at school."
Vaccinating your child also protects others in the community who may not be able to get immunized or who are more at risk of serious illness, says Dr. Fernando.
In short? "Vaccinations save lives," Dr. Fernando says.
Parents can currently get their little ones vaccinated at pediatrician offices, pharmacies, federally qualified health centers, local health departments, clinics and other locations around the country.
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