COVID-19 Booster for Kids Under 12: What Parents Need to Know

Government health agencies have given the green light to the Pfizer-BioNTech’s COVID-19 vaccine booster for children ages 5 to 11. Amy Edwards, MD, pediatric infectious disease specialist at University Hospitals Rainbow Babies & Children's, helps answer parents’ most common questions.

Q. When is my child eligible for a booster?

A. Children ages 5 and older are eligible for the booster five months after their second dose of the Pfizer-BioNTech vaccine.

Q. Why should my child get a booster?

A. The vaccine is highly effective, but its effectiveness decreases over time which is why we recommend a booster. The most recent study looked at the efficacy of a third dose of the vaccine in 4,500 children and found a 36-fold increase in antibody levels—specifically antibodies that are active against Omicron. In light of our rising Omicron numbers, this is a necessary tool in the arsenal to fight ongoing covid infections.

The vaccine keeps people out of the hospital. It keeps people from dying. And it’s 97% effective at preventing children from having multi-system inflammatory syndrome (MIS-C), which is huge. In adults, the vaccine reduces the risk of long-haul covid and it probably does the same in kids. It’s also very safe—the safety data is even better in kids than it is in adults.

Q. If my child had COVID-19 do they still need a booster shot?

A. The data shows that a natural covid infection does act as a very effective booster. I would still boost my child, especially if it’s been three or more months since their infection, because I would want ongoing protection for my child. There’s a lot of good data that mixing things up—natural infections with boosters—provides high level and longer-lasting protection.

Q. Isn’t it rare for most kids this age to get seriously ill from COVID-19? Why vaccinate them?

A. The data does show that the vast majority of kids who get COVID-19 in the 5 to 11 age group do okay. That's not everybody. Kids are at less risk than adults, but kids are not no-risk.

About 50 percent of kids with COVID-19 will be asymptomatic. Then about 30 to 40 percent will be symptomatic, but will be mild enough that they'll be able to stay at home. Then another 10 to 20 percent are going to be sick enough to need to be in the hospital.

And the difference between kids and adults is that in adults, there's a well-delineated risk. We know high blood pressure, diabetes, obesity and heart disease put you at high risk compared to adults without those conditions.

With kids, the risk is less clear. There are some things like having Down syndrome or having an organ transplant that we know increases your risk. But then there's a bunch of kids who just get severe COVID with no obvious risk factors. And it's not clear why them and not others. Recent data shows that up to 30 percent of children who have been admitted to the hospital with COVID-19 had no underlying risk factors for severe disease. So, in the absence of a crystal ball to tell me whether my children are at increased risk or not, and with a very safe and effective vaccine, it just seems logical to take my child's low risk and reduce it even further.

Q. When health agencies approved the vaccine for adolescents ages 12-15, some parents were reluctant. What did we learn from that?

A. There was understandable hesitation for some parents. Many of them were willing to get the vaccine, but had fears around the idea of putting the vaccine into their kids’ bodies.

What we discovered is exactly what we already knew, and that is that the vaccines are safe and effective. Yes, there are rare side effects, but they are rare: one in a hundred thousand, one in a million type thing. I don't think there's any difference for younger people.

Q. What should parents who are worried about the vaccine be asking themselves?

A. The real risk-benefit question is what might happen to my kid if I vaccinate them, versus what might happen to my kid if they get COVID-19.

Q. What about the risks of getting COVID-19 versus the risk of getting vaccinated?

A. The risk of having a negative outcome from COVID-19 is much, much higher than the risk of having a negative outcome from the vaccine. Problems from the vaccine  -- fever, muscle aches, not feeling well, even rare and extremely mild heart inflammation called myocarditis that you've heard people talk about -- are all temporary and resolve typically within a day or two,

The damage that the virus can do is much more significant than that, and typically does not resolve in 24 to 48 hours. We have kids that have gotten the same kind of heart inflammation, except it lasts for weeks or for months. We have kids who, four weeks after getting COVID-19, then get Multi-System Inflammatory Syndrome, which can lead to intensive care unit admissions and severe outcomes. And then you have the kids who get long-haul COVID that lasts for months or possibly years.

It's really no comparison at all. The vaccine is hundreds of times safer than the virus.

Q. What have you seen in terms of severe cases in this age group?

A. I've seen a 5-year-old on a ventilator. I've seen kids 7, 8, 9 years old with COVID-19 long haul in my COVID-19 recovery clinic who are now struggling with the long-term effects on their health. These kids can't play sports and some can hardly attend school because they're so fatigued from long haul COVID-19.

I've seen kids who have problems with learning, memory and cognition after suffering from severe COVID-19. It's no joke what COVID-19 can do to children.

And I get that it's not every child, right? And thank goodness, it's not. It is a minority of kids, but we cannot predict which child is going to have that bad outcome and which child is going to sail through COVID-19 with no problem. We have this amazing, safe tool to protect our children. We should all be using it.

Q. You are vaccinating your child?

A. My daughter is 5, and I made an appointment to get her vaccinated because it is in her best interest. I do not know if she would have severe outcomes from COVID-19, but it's a risk I'm not willing to take with her health.

Q. Is it okay for a child to get the COVID-19 vaccine or booster at the same time as other childhood vaccines or flu vaccine?

A. Most kids in the 5 to 11 age group have already gotten their kindergarten shots. And then you typically don't need shots again until like high school or so, except for the yearly flu shot. But yes, it is perfectly safe to combine your COVID-19 vaccine or booster with any other vaccine. There's no problem there at all.

Q. The FDA recommended a low-dose vaccine and booster for kids 5 to 11. If your child is, say, 11½, does it make any sense to wait until age 12 so they can get the full dose?

A. I would not wait. I would get my child vaccinated or boosted at that lower dose. And the reason is because the lower dose comes with fewer side effects, and that booster will then kind of tip their immunity up to an even higher level. You'd kind of get the best of both worlds by doing it that way.

Q. Where can parents get more information?

A. There's a lot of information on the Internet and anybody can put it there, whether it’s true or not. I understand the information pressure that parents are under. It can be really difficult to understand what's true and what's not true. So take your concerns to your pediatrician and talk it over with them.

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Vaccinating children against COVID-19 helps provide immunity for youngsters, while helping to stem the spread of the virus and curb mutations that lead to new, more severe virus variants. Find out about the authorized vaccines, how they work, possible side effects and the benefits of having your children vaccinated.