Boy getting a COVID vaccine

The physicians and staff of University of Maryland Children's Hospital understand that parents have a lot of questions about the COVID vaccine now that the Pfizer BioNTech vaccine is available to children age 5 and up.

We have compiled the questions we heard from parents, and our experts answer them for you.

Dr. Andrea Berry is a pediatric infectious disease expert at University of Maryland Medical Center, and Dr. Rebecca Carter is a primary care pediatrician at UM Midtown Pediatrics.

Learn more about:

More: Q&A: Protecting Our Kids

Who Needs to Be Vaccinated and Why

I thought children were low-risk for COVID-19. Do they still need to get the vaccine?

Dr. Carter: Absolutely! Though many children have mild disease, there is still a portion that has become quite ill from COVID, with many hospitalized and even a number of pediatric deaths. We also have seen many longer-term complications that make it a higher risk to kids than other common viruses.

Additionally, it is the best way to contribute overall to lowering the spread in our community, and kids can play an important role in ending this pandemic.

See these 7 reasons to get the vaccine.

I'm vaccinated, but my child is not. Can I still give COVID-19 to them?

Dr. Carter: Unfortunately, yes. Vaccinated people are less likely to spread the virus due to lower amounts of virus overall, but if exposed, they may carry the virus and not have symptoms. This means they can still spread to others who are unvaccinated. It is important to get all eligible children vaccinated to decrease the spread and protect the population that is not yet eligible.

Dr. Berry: Vaccinated people are less likely to get infected, and when infected, they are less likely to transmit the virus to others. Vaccination is a good idea for children because they will interact with other people besides their parents.

Although many children have mild disease, some are hospitalized, and COVID-19 was the tenth leading cause of childhood death in the United States during the first year of the pandemic.

My child had COVID-19. Do they still need the vaccine? If so, will they have a bad reaction?

Dr. Berry: If eligible based on age, we recommend that your child who had a COVID-19 infection still get the COVID-19 vaccine. Although reinfection has not occurred frequently, it does occur, and in rare cases, it has happened soon after the original infection.

The CDC does not recommend delaying vaccination after COVID-19 infection in most cases.

There are some exceptions:

  • Your child must wait at least until they are symptom-free and their quarantine period is over.
  • Similarly, if they got a COVID-19 infection after their first vaccine dose but before their second dose, your child should delay the receipt of the second dose until they are symptom-free and their quarantine period is over.
  • If your child received a monoclonal antibody as a treatment for COVID-19 illness, they should wait at least 90 days before being vaccinated.
  • If your child had multisystem inflammatory syndrome in children (MIS-C), you might want to speak with your child's doctor about the timing of COVID-19 vaccination.

Please see this vaccine information for detailed information about these exceptions.

People who have had COVID-19 illness and then get a vaccine have had robust immune responses, suggesting that the vaccine produces a beneficial effect.

In more than 26,000 study participants who received the Pfizer-BioNTech COVID-19 vaccine, no specific safety concerns were identified in the subgroup of people who had a previous COVID-19 infection. Therefore, you could expect that your child would react similarly to the vaccine as other children who did not have a previous COVID-19 infection.

Getting Your Child Vaccinated

Why does my child need to go to a mass vaccination site and not my child's pediatrician?

Dr. Carter: We strongly recommend that you contact your pediatrician and seek to get vaccinated with their office if it is available, as this will create a safe and nurturing environment for your child as they get the vaccine.

However, there are some practices that do not yet have a supply of vaccines for all ages. In those cases, we do not recommend waiting longer to get vaccinated, as the sooner your child gets the vaccine, the sooner they are protected.

In those cases, we recommend seeking a friendly environment such as those provided by school-based vaccination clinics or sessions set up by your local health department.

Find a vaccination location for people age 5 and up.

Can a child get another vaccine and a COVID vaccine at the same time?

Dr. Carter: Yes - the CDC has removed all restrictions around receiving the COVID vaccine and other vaccines at the same time. This is based on evidence from many other vaccines studied that demonstrate that this is a safe choice and improves protection against COVID and many other viruses.

Do over-the-counter medications prevent the effectiveness of vaccines?

Dr. Berry: A previous study showed that infants who received acetaminophen had lower immune responses to some vaccines. Therefore, it is recommended that medications like acetaminophen and ibuprofen not be given as a preventative measure at the time of vaccination.

But they can be given in response to symptoms that may develop, such as fever and injection site pain. Of note, even if medications are given, it is most likely that the immune response will be strong enough to prevent COVID-19 illness.

After Your Child's Vaccine

Side Effects

What pain medicine should we use to help our kids with vaccine side effects?

Dr. Carter: In general, there is no requirement to give any pain medication. However, if your child has some of the common side effects of the vaccine, feel free to give a dose of acetaminophen or ibuprofen as needed.

We do not recommend pre-treatment with medication prior to developing these symptoms to maximize your child's immune response to the vaccine.

What are the immediate side effects of the COVID vaccine?

Dr. Carter: Many children may have no side effects at all. Others may notice a sore arm, some enlarged lymph nodes (lumps and bumps) in their armpit and may develop a fever (for a short period of time), chills and fatigue or body aches. These are all self-limited symptoms that generally do not last more than 24 to 48 hours.

Side effects are generally significantly milder than the effects of active COVID might be if your child were to get a true infection.

Please see this vaccine information for detailed information about side effects.

Will this vaccine give my child a blood clot?

Dr. Berry: There is no known association between receiving an mRNA vaccine and developing a blood clot. The United States Vaccine Adverse Events Reporting System was able to detect the very rare occurrence of blood clots following the Johnson & Johnson adenovirus-vectored vaccine (3 in 1 million) after 6 weeks of vaccination.

Life After the Vaccine

After my child gets a COVID vaccine, can I stop wearing a mask?

Dr. Carter: After your child completes the full vaccination (which is 2 weeks after their second vaccine dose), your household is likely protected if all other household members are also vaccinated, and there are no high-risk individuals (such as with compromised immune systems).

You should still follow all state and federal guidelines for mask-wearing but can feel more comfortable foregoing a mask if you choose around other vaccinated individuals. Indeed, the best path towards ending the pandemic and a return to normalcy includes getting everyone eligible vaccinated as soon as possible!

Can we travel as a family if some of our kids are vaccinated but others are not?

Dr. Carter: If you do not have a completely vaccinated household, you should continue to take precautions to prevent infection and keep the non-vaccinated individuals safe. You can absolutely participate in safe travel, such as travel by car or private vehicle, and socially distanced or outdoor activities.

Once all members of your house are vaccinated, you should not feel the need to restrict travel, but should continue to follow the recommendations for mask wearing based on the local district requirements.

Long-Term Questions About the Vaccine

What are the long-term effects of the COVID vaccine on growing kids?

Dr. Carter: While we do not yet know long-term effects on children since this vaccine is new, we do have evidence of its safety of over a year for adults and over 6 months for kids, and we know that vaccines in general demonstrate effects in the first few days and weeks after vaccines. The mRNA component of the vaccine degrades rapidly and has not been shown to be present in a manner that should scientifically allow for a possible long-term effect in children.

We also know that COVID infection has substantial risks for children for long-term negative outcomes, including prolonged symptoms, difficulty with breathing and thinking and an inability to return to normal activities. As a result, we strongly believe the vaccine is a safer alternative to risking COVID infection and encourage it strongly for all eligible children.

Dr. Berry: We hope that immunity to COVID-19 will be a long-term effect, but we do not yet know how long immunity will last. There are no known long-term adverse effects following any COVID-19 vaccine.

Will the shot affect my daughter's fertility?

Dr. Berry: No. There has been misinformation that mRNA vaccines, like the Pfizer and Moderna vaccines, can affect fertility, but no evidence that COVID-19 infection has impacted fertility.

During the licensure study for the Pfizer-BioNTech COVID-19 vaccine, 23 pregnancies were reported in participants, with balanced numbers of pregnancies in the vaccine and the placebo groups.

Vaccine Research, Safety and Approval for Children

When will the CDC approve other vaccines (Moderna, Johnson &Johnson) for adolescents?

Dr. Berry: For adolescents age 12 and up, Moderna has completed a study of their mRNA vaccine in 12-17-year-old children that reportedly showed high efficacy, good immune responses, and no significant safety concerns. An Emergency Use Authorization (EUA) application to the Food and Drug Administration has been submitted.

The Novavax vaccine, which is a protein subunit vaccine, is currently being tested in 12- to 17-year-old adolescents, including at the University of Maryland School of Medicine. The Johnson & Johnson vaccine is being tested in 12- to 17-year-olds in Spain and the United Kingdom and a number of other countries, with plans to expand testing in the United States.

When will vaccines be authorized for babies and children 6 months – 11 years old?

Dr. Berry: For children, Pfizer and Moderna are currently testing their mRNA vaccines in younger children. The University of Maryland School of Medicine is conducting the pediatric Moderna trial and has been vaccinating children as young as 6 months old.

The studies take time because the vaccines are tested first in older age groups before moving to younger age groups. First, lower doses are tested (e.g., half of the adult dose) before full doses are tested.

Is the vaccination dosage different for kids?

Dr. Berry: In general, the studies are designed to test smaller doses in older kids before moving on to test larger doses in those older kids and then smaller doses in younger kids. This way, safety can be assessed with each new vaccine dose and age group tested.

Ultimately, they will choose the best dose that does not cause too many side effects while optimizing the immune response. This dose could be the same or different for different age groups of children, depending on side effects and immune responses.

After the optimal doses are chosen, larger clinical trials with more children who are randomized to receive either vaccine or placebo will be conducted to look for more uncommon side effects, immune responses and effectiveness.

Learn more about how the COVID vaccines were developed and tested.

Updated 11/17/2021

UMMS provides our expert-reviewed content to keep our community informed. When sharing this copyrighted content, please link to our site so that critical updates are reflected.