• COVID-19 Vaccine for Children and Adolescents

    Updated March 9, 2022

    The rapid rise in childhood cases and severe illness from the Delta and Omicron variants underscore the need to vaccinate this age group, as the risk for severe and long-lasting adverse health outcomes in unvaccinated children is significant. The FDA and CDC have confirmed the vaccine’s safety and efficacy for children and adolescents. 

    Recent News

    AAFP Reinforces Stance on Importance of COVID-19 Vaccines for Children in Response to State of Florida's Potential Recommendation

    Recently the Florida Department of Health announced plans to recommend that healthy children not receive the COVID-19 vaccine. The AAFP reaffirms the likelihood of infection and the health risks associated with COVID-19 outweigh any potential risks associated with COVID-19 vaccines. Vaccination is important in protecting children from the potential of severe inflammatory disease (MIS-C) and long COVID. Children can also spread COVID-19 to others, so getting them vaccinated is another way to protect families and community from severe disease.

    Read the AAFP's March 8 statement, Family Physicians Urge All Eligible Children and Adults to Get Vaccinated Against COVID-19.

    Adolescent Vaccine (Ages 12-15)

    In May, the CDC’s ACIP recommended the Pfizer-BioNTech vaccine for individuals aged 12–15 in the U.S. following the FDA amending its EUA to include individuals 12 to 15 based on safety and efficacy data, which showed 100% effectiveness in the vaccine group (0 cases) compared to the placebo group (16 cases). 

    On Jan. 5, the FDA authorized and the CDC recommended a single booster dose of the Pfizer-BioNTech vaccine at least 5 months following completion of a primary series for individuals aged 12-17. This recommendation was based on updated safety and efficacy data and the potential for waning protection against infection with the newer variants.

    Additional doses for individuals 12 and older who have moderate to severe immunosuppression were recommended previously and are eligible for a booster at 5 months after the third dose of their primary series. The EUA Fact Sheets have been updated to reflect these changes.

    The COVID-19 Vaccine for Ages 12 to 15 article on Familydoctor.org is a patient-friendly resource to share. 

    More Information on Current Adolescent Vaccines (Ages 12-15)

    Child Vaccine (Ages 5-11)

    Pfizer-BioNTech Child Vaccine Approved 

    Additional doses are recommended for children 5-11 who have moderate to severe immunosuppression. 

    On Jan. 3, the CDC issued an updated recommendation that all individuals over the age of 5 receive an additional dose of the Pfizer-BioNTech vaccine. This dose is considered part of the primary series and these individuals should get a booster dose at least 5 months later. Read more on staying up to date with your COVID-19 vaccinations.

    On Nov. 3, the CDC recommended the COVID-19 vaccine for children 5-11 years old. They agreed the clinical trial demonstrated the Pfizer-BioNTech COVID-19 vaccine is safe and effective in this age group, and that it can reduce the devastating impact of COVID-19 on children. The Pfizer-BioNTech vaccine (10ug) will now be available for all children in this age group under the FDA’s EUA.   

    AAFP's statement, AAFP Applauds FDA’s Emergency Use Authorization of COVID-19 Vaccines for Children Ages 5-11, emphasizes that children need equitable access to a safe, effective vaccine and they should be quickly distributed to primary care physicians.

    On Oct. 29, the FDA authorized use of the Pfizer-BioNTech COVID-19 vaccine for children 5-11 years old. The authorized vaccine is at a different dose and will be shipped separately from adult doses. It will still be a 2-dose series with 3 weeks between doses. In data presented to the committee, this dose induced comparable antibody levels as seen in adolescents and young adults, and was 90% effective at preventing symptomatic COVID-19. Side effects were similar, if not lower, than those in adults. No cases of myocarditis, anaphylaxis, or death were observed.

    Pediatric vials, which are different from those used for adolescents and adults, will need to be diluted per instructions for the correct dose (see table below). More information can be found in the Pfizer Quick Reference Guide.

    The COVID Vaccines for Younger Children: What Parents Need to Know on Familydoctor.org is a patient-friendly resource to share. 

    Comparing Child and Adult Vaccine Attributes


    Childhood (Pediatric) Vaccine
    (ages 5-11)

    Adolescents and Adult Vaccine
    (ages 12 and older)

    Vial description Orange top Purple or gray tops
    Dose 10 mcg 30 mcg
    Doses per vial 10 doses per vial 6 doses per vial - not that gray top vials don't need to be diluted

    Answering Patient Questions

    This frequently asked question list can help you discuss the COVID-19 vaccines with your patients and parents/caregivers. Refer to the CDC's Clinical Considerations for more detail. The AAFP's Familydoctor.org also offers patient-friendly articles on COVID-19. 

    What vaccines are available for children and adolescents?
    Currently, the Pfizer-BioNTech mRNA vaccine has been authorized/recommended for children and adolescents aged 5-15. Adolescents (12-15) receive 2 doses of the adult formulation where as children (5-11) receive 2 doses of a different formulation at a lower dose. This lower dose resulted in a robust immune response and was seen to be 90% effective at preventing symptomatic disease. Children’s immune systems are much more responsive so this lower dose works well for them. Vaccines, unlike other medications, are recommended by age and not body weight.

    Why should my child get the vaccine?
    Children and adolescents can get COVID-19 just as easily as adults and can transmit it to others. There have been almost 2 million cases reported in children resulting in over 80,000 hospitalizations and 94 deaths in children aged 5-11. These rates are much higher than rates observed for diseases that we already routinely immunize children against. Vaccination is also important in protecting children from the potential of severe inflammatory disease (MIS-C) and “Long-COVID.” Children can also spread COVID-19 to others, so getting them vaccinated is another way to protect your family and community, especially those who are most vulnerable.

    What if my child turns 12 before their 2nd dose?
    The CDC is recommending that children get the vaccine that is recommended for their age on the day of vaccination. So they should receive a dose of the adolescent/adult vaccine if they have turned 12. However, the FDA authorization allows for flexibility and they can still receive a second dose of the child vaccine if needed and will be considered fully vaccinated. View the updated CDC Clinical Recommendations

    Does my child need a booster dose? 
    Yes, if they are 12 years or older. A single booster dose of the Pfizer-BioNTech vaccine is recommended for all individuals over the age of 12 at least 5 months following completion of their primary series.

    What if my child is immunocompromised?
    Similar to adults, children 5 years and older who have moderate to severe immunosuppression should get an additional primary series dose of Pfizer-BioNTech.

    Should I get my child vaccinated if they have already had COVID-19?
    Yes, the CDC is recommending all children aged 5 and older get vaccinated regardless of their past infection history.
    There is increasing evidence that vaccination after COVID-19 actually increases protection against reinfection including against the recent more infectious variants. In the clinical trial, there were no effects on the immune response or side effects in children who were seropositive (past infection). Additionally, there is extreme variability in immunity after infection and there is data showing lower antibody levels in people who had an asymptomatic infection.

    Is the vaccine safe for children?
    Yes. The vaccines will not give your child COVID-19.
    They do not cause fertility problems and do not contain tracking devices, microchips, or luciferase so your children will not glow after receiving the vaccine. As with all medications and vaccines, there are rare instances of allergic reactions. Talk with your family physician about these rare events, particularly if your child has a history of anaphylaxis or if they are allergic to any of the components of the vaccine. The vaccine formulation for children is different and uses a different buffer than the adult, but this buffer is used in other vaccines and is completely safe. 

    What are the side effects of the vaccine in children?
    Children may experience fewer side effects than adolescents or young adults. Children with evidence of prior infection may have fewer side effects than those without evidence of prior infection. The clinical trial showed that children had similar, if not fewer, side effects than adults. You may see pain, redness, or swelling at the injection site. There is also a chance they may develop fever, fatigue, headache, chills, muscle or joint pain, or swollen lymph nodes. There were no serious side effects observed in the trial.

    Should I be worried about them getting myocarditis?
    Myocarditis, inflammation of the heart, has been observed in some individuals following receipt of one of the mRNA COVID-19 vaccines. However, these have been rare events—only around 700 out of almost 200 million people who have received at least one dose of the vaccine. Most cases were mild and resolved within a few days after vaccination. There were no cases of myocarditis/pericarditis observed in the clinical trial in children aged 5-11. Myocarditis is fairly common after viral infections, and the risk of myocarditis is 16-times higher with COVID-19. 

    Should I give my child/adolescent pain medications before getting the vaccine?
    It is not recommended for people to take pain relievers before getting the vaccine as it is not known how these medications may affect how well the vaccine works. Get tips on relieving pain and discomfort AFTER the vaccine.  

    What does it cost to get the vaccine?
    COVID-19 vaccines available at no cost
     to individuals, and clinicians administering the vaccine will be reimbursed for vaccine administration. See guidance on coding and payment.

    How do I know where to find the child vaccine?
    You can search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you. These services will be updated with information as soon as it is available.

    What should I do to monitor my child after vaccination?
    Enroll in V-Safe. It's a free, easy-to-use, and confidential smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after your child receives a COVID-19 vaccination. Through v-safe, you can report how your child is feeling after getting vaccinated. V-safe also reminds you when to get your child’s second dose.

    Information for Providing Child COVID-19 Vaccines 

    1. Make sure you're registered with the CDC to provide the COVID-19 vaccine.  
    2. Check with your local jurisdiction to make sure you're registered, and get updates on distribution and allocations..  
    3. You'll need to report your vaccine supply to VaccineFinder so that your location is displayed on vaccines.gov. Parents and caregivers will be directed to vaccines.gov to find locations offering COVID-19 pediatric vaccines. 
    4. Review the Pediatric COVID-19 Vaccination Operational Planning Guide. 
    5. Make sure you and your team are comfortable with the pediatric vaccine storage and handling requirements.
    6. Review the updated clinical considerations from the CDC.
    7. Watch the AAFP's COVID-19 vaccine web page for additional information.  

    Planning Resources