Why should you, or shouldn't you, consider vaccinating your kids for COVID-19? Are some children better candidates for the vaccine than others? We got answers from two pediatric specialists. Plus, get tips on how to keep unvaccinated kids healthy.

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Just shy of 50% of Americans are fully vaccinated for COVID-19, and COVID cases are surging again. (Statistics are representative of when this article was written.)

Even more worrisome: the Delta variant is now believed to be more contagious than the common cold or the seasonal flu, just as contagious as chickenpox and twice as contagious as the original COVID-19 strain, according to reports of an internal CDC document.

It's not too surprising then that, as adults, we're hearing more and more about the importance of getting vaccinated for COVID-19.

But what about our kids? Is it safe to vaccinate children for COVID-19?

A hand holding a COVID-19 vaccine bottle with a young girl in the background wearing a mask
Credit: Getty Images / Navinpeep / Ivan Pantic

Currently, only children 12 years and older can get vaccinated. None of the vaccines have been approved in the U.S. for younger kids. Yet! The prediction is that the Pfizer and Moderna vaccines might get the green light within six months.

"Using my cloudy crystal ball, I am hoping we'll see the Pfizer vaccine for 5- to 12-year-old children approved in November [2021]," says Sharon Nachman, M.D., director of the Office of Clinical Trials and division chief of pediatric infectious disease at Stony Brook Children's. "Then for under-5-year-olds, shortly thereafter. With regard to Moderna, I think we won't see them until December [2021] or January [2022]."

As for the safety of the vaccine, per Nachman, the benefit seems to outweigh the risk. Also, the aim is always the greatest safety, and—as a result—many, many trials are conducted before a vaccine is distributed.

"The big picture in medicine is that we want to prevent any morbidity and mortality. And while kids don't necessarily die from COVID-19, what if they did? We want to prevent all kids from dying. We also want to prevent hospitalizations. That's why we vaccinate them for other illnesses, not just COVID," says Nachman.

And with the Delta variant being highly transmissible for not just adults but also children, we have an even more compelling reason to get the vaccine and practice masking, social distancing and good hygiene practices (like regularly washing our hands).

Nachman had an excellent analogy: When you get in a car and you take my child in the car with you, I want you to seat-belt my kid or put them in a car seat. I don't want them just hanging out in the back seat. I think of vaccines in the same way—they're there, we should use them. And they can prevent further damage.

Right now, the most sick people—kids and adults—are in areas where vaccination rates are lowest. "We're seeing a lot more kids getting sick in states where there is a high population of unvaccinated adults. In states where the vaccination rate is under 40%, it looks like the original surge," says Nachman. "And in addition to seeing more kids getting sick, we're seeing more getting hospitalized."

What about the cases of myocarditis I'm hearing about?

One of the illnesses that's arising in children with COVID-19 is myocarditis. "Myocarditis is inflammation of the heart muscle. It can lead to the heart not squeezing well and having crazy rhythms since the electrical circuits of the heart also run through the inflamed muscle," explains Leslie Rhodes, M.D., M.B.A., a pediatric intensivist in the cardiovascular intensive care unit at Children's of Alabama and an associate professor of pediatrics at the University of Alabama at Birmingham.

There is also a small risk of getting myocarditis after receiving the vaccine for COVID-19. But, statistically speaking, only a handful of cases of myocarditis per million vaccine doses have been documented.

"Thus far, most of the kids I have seen with myocarditis from the COVID-19 vaccine have chest pain, from the inflamed muscle, and elevated heart muscle enzymes, which have all improved over time," explains Rhodes. And while the risk of myocarditis is very real and can be quite serious, Nachman pointed out that the children with myocarditis from the vaccine—for the most part—are treated (often with something like Advil) and sent home from the hospital within days. "The cases of myocarditis in kids with COVID are more severe—and unfortunately those kids are quite sick," says Nachman.

Overall, it's more likely that a child will get myocarditis from COVID-19 than they will from the COVID-19 vaccine. "When I talk about the risk of myocarditis associated with the COVID vaccine and the risk of myocarditis if you get COVID, the risk of getting myocarditis if your child gets COVID is higher," says Nachman. Myocarditis isn't the only illness kids get from COVID-19. Multisystem inflammatory syndrome in children (MIS-C) is a condition where not just the heart becomes inflamed, but other body parts, including the lungs, kidneys, brain, skin, eyes or gastrointestinal organs, can become inflamed also. MIS-C is quite serious, requires medical care and is seen in kids who have COVID-19 or have been exposed to COVID-19.

How to keep unvaccinated kids healthy

If your child is unvaccinated, many of the tactics we've been practicing since the pandemic arrived still apply. And with school starting back up in the coming weeks, here's Nachman's expert advice:

  • If your child is sick, don't send them to school. While you don't know what they have, you don't want them to pass it to others, especially if it's COVID-19.
  • New CDC guidance issued on August 5, 2021, suggests masks should be worn indoors by all individuals (teachers, staff, students and visitors) in K-12 schools (age 2 and older), regardless of vaccination status. Even if your child has been fully vaccinated (so is less likely to get sick), it's the safest option to just have everyone mask up. Wearing a mask cuts transmission both ways, so they further protect everyone—vaccinated or not.
  • If your kids participate in extramural activities, they should wear a mask. Unlike in the classroom where you might know who is vaccinated and what social distancing practices are in play, we often know very little, if anything, about the other kids in extramural activities. While it's not fun to wear a mask, it's not fun to be hospitalized.

The bottom line

We have no way of knowing which child will get myocarditis from COVID-19, or myocarditis after the vaccine, nor can we predict which kid will have the worst of the post-COVID illnesses. "We don't have those answers yet," says Nachman.

"I think families are always nervous with something new," says Nachman. But generally speaking, even though these are new, vaccines have changed our lives for the better and they've changed childhood illness that kill kids. "Vaccines have changed morbidity and mortality in children. When I was a young doctor, we saw two to three cases of meningitis in a month. Our current generation of young doctors have never seen a case of meningitis," says Nachman.