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Pediatric COVID-19 Vaccination
Pfizer-BioNTech and Moderna COVID-19 vaccines are authorized for use in people 6 months and older. The Novavax COVID-19 vaccine is authorized for use in people 12 years of age and older.
If you are new to using COVID-19 vaccine, there are several critical differences in the storage and handling, administration, and clinical considerations for COVID-19 vaccine compared to routine immunizations. The COVID-19 vaccines for children under 12 are different formulations identified by specific-colored caps.
- The Pfizer COVID-19 vaccine for 6 months through 4 years is identified by a yellow cap. The Pfizer COVID-19 vaccine for 5 through 11-year-olds is identified by a blue cap. Make sure you have the correct vaccine and know how to use it.
- The Moderna COVID-19 vaccine for children 6 months through 11 years is identified by a blue cap/green label.
- Children age 6 months through 4 years may need multiple doses of COVID-19 vaccine to be up to date, depending on the number of doses they've previously received and their age. Everyone age 5 years and older should get one Pfizer or Moderna 2024-2025 COVID-19 vaccine to be up to date. For more details refer to CDC: Staying Up to Date with COVID-19 Vaccines.
Key things to know and share with patients
All parents/guardians and patients must receive an emergency use authorization (EUA) fact sheet or vaccine information statement (VIS) before vaccination and have their questions answered.
- FDA: Pfizer-BioNTech COVID-19 Vaccine
Fact sheets for recipients and caregivers are available in many languages. - FDA: Moderna COVID-19 Vaccine
Fact sheets for recipients and caregivers are available in many languages. - FDA: Novavax COVID-19 Vaccine, Adjuvanted
Fact sheets for recipients and caregivers are available in many languages. - CDC: Vaccine Information Statement: COVID-19 (PDF)
Parent or guardian consent is needed for vaccination, except under certain circumstances. Refer to Minnesota Statutes, sections 144.341 (minor living apart); 144.342 (minor who has given birth or been married) and 144.345 (recognizing good faith reliance upon representations of the minor).
- Explain what side effects to expect and how to manage them.
- Vaccination providers should consider observing vaccine recipients for at least 15 minutes after vaccination, especially adolescents.
- If indicated, make an appointment before they leave to get the next dose per the CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines vaccination schedule.
- Do your part to reach adolescents and children in Minnesota hit hardest by COVID-19.
Benefits of pediatric vaccination talking points
Use these talking points to help convey the importance of COVID-19 vaccination for adolescents and children.
- The COVID-19 vaccine remains very effective at preventing hospitalizations, intensive care stays and death in children and teens. COVID-19 can be severe for children and adolescents, even children who do not have underlying health conditions, and we can't predict who would get very sick.
- Because variants may spread easily, it is possible children or teens could still get COVID-19 after being vaccinated, but it's very unlikely they would get very sick from COVID-19.
- The immune response to two doses of Moderna vaccine or three doses of Pfizer in children 6 months through 4 years produced a high level of response.
- The clinical trials for children under 11-years-old did not have any reports of these rare side effects: myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the lining outside the heart), or anaphylaxis (an allergic reaction). Learn more at CDC: Myocarditis and Pericarditis After mRNA COVID-19 Vaccination.
COVID-19 is still spreading in our communities. We have more tools available β such as COVID-19 vaccines, testing, and medications β to help manage this disease, and itβs important for us to continue using these and other strategies to keep COVID-19 from spreading.
There is no need to wait to give the COVID-19 vaccine if the child needs other vaccines at the same visit.
- The most common side effects are injection site pain, tiredness, headache, chills, muscle pain, fever, and joint pain. Side effects occur more frequently following the second dose.
- These side effects mean the immune system is responding to the vaccine. It's also OK if the child does not have side effects β people respond to the vaccine in different ways.
Vaccine administration tips
- Answer any questions the child or parent/guardian has about vaccination.
- Use comfort measures to decrease pain and anxiety. Suggest the child:
- Listen to their favorite music with headphones.
- Breathe! Take slow, deep breaths.
- Make eye contact with a supportive person.
- Close their eyes and think of a favorite place or activity.
- Focus on something in the room, like a poster.
Young children should sit in parent's lap with the parent embracing their child. Instruct the parent to use one of the recommended comfort holds.
- CDC: How to Hold Your Child During Vaccination
- CDC: Comfort and Restraint Techniques (YouTube)
Holding infants starts at 1:39, and holding older children start at 3:30 in the video.
How to hold your child during a vaccination (PDF)
Fact sheet with images and instructions for different comfort holds. Created in partnership with Homeland Health Specialists. Updated 6/17/22.
- How to hold your child during a vaccination in Amharic (PDF)
- How to hold your child during a vaccination in Arabic (PDF)
- How to hold your child during a vaccination in Chinese (PDF)
- How to hold your child during a vaccination in French (PDF)
- How to hold your child during a vaccination in Hmong (PDF)
- How to hold your child during a vaccination in Karen (PDF)
- How to hold your child during a vaccination in Lao (PDF)
- How to hold your child during a vaccination in Oromo (PDF)
- How to hold your child during a vaccination in Russian (PDF)
- How to hold your child during a vaccination in Somali (PDF)
- How to hold your child during a vaccination in Spanish (PDF)
- How to hold your child during a vaccination in Vietnamese (PDF)
Front hold
Demonstration: Front Hold Transcript (PDF)
Comfort hold
Demonstration: Comfort Hold Transcript (PDF)
Straddle hold
Demonstration: Straddle Hold Transcript (PDF)
Side sit hold
Fainting (syncope) can be common among children immediately after getting shots. For this reason, experts recommend having patients sit in a chair or lay down when they receive a vaccination. In addition, patients may be observed for 15 minutes after vaccination. For more information, visit CDC: Fainting and Vaccines.
All vaccine administration has the risk of anaphylaxis. All adverse reactions and vaccine administration errors should be reported to the Vaccine Adverse Event Reporting System (VAERS).
Find ways to decrease barriers for families
- Aim to offer multiple ways to schedule and/or allow walk-ins for COVID-19 vaccination.
- Extend hours: Try to offer early morning, evening, or weekend appointments for caregivers to bring in children for COVID-19 vaccination.
- Consider working with schools, local health departments, other local community organizations, or mobile vaccination units to help facilitate community vaccination drives specifically for children and families from areas with high social vulnerability factors.
- Find a list of MDH's COVID-19 Community Coordinators and Engagement Contractors at COVID-19 Contracts for Diverse Media Messaging and Community Outreach.
- The Minnesota Immunization Information Connection (MIIC) can be used to identify patients in specific ZIP codes who have yet to receive COVID-19 vaccine and/or their routine immunizations. Using the client follow-up functionality in MIIC, providers can pull a list of clients and their contact information (including ZIP code). The user guidance for this function can be found at Client Follow-Up.
Reach out to highly impacted communities
Consider reaching out to children and families in communities that have experienced a high burden of COVID-19 disease and impact, including:
- Black, Indigenous, Hispanic, and Asian Pacific Islander communities
- Children with disabilities
- Children with other medical comorbidities per CDC guidance: People with Certain Medical Conditions.
- Children from households where the language spoken is not English (e.g., Somali, Spanish, etc.)
- Children on Medicaid/Minnesota Health Care Programs