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Parents with kids who are almost 12 years old should not be concerned about getting a smaller dose of COVID-19 vaccines. Michael Loccisano/Getty Images
  • Both the FDA and the CDC this week approved Pfizer’s pediatric COVID-19 vaccine for 5 to 11 year olds.
  • In the U.S., children ages 12 and older get the full regimen of COVID-19 vaccines — 2 full doses, like adults, whereas those younger get about a third of it.
  • This has left parents of 11-year-olds on the cusp of turning 12 confused about the timing and dosing of COVID-19 vaccines for their children.
  • Experts say it is best to get whatever vaccine is available right away rather than hold out for a full dose as there won’t be much of a difference in kids’ immune responses at that age.

The Centers for Disease Control and Prevention (CDC) gave its final OK for children 5 to 11 years old to be vaccinated against COVID-19 after formally recommending on Nov. 2 that they get the Pfizer-BioNTech pediatric vaccine.

One big difference between the pediatric and adult vaccine doses is the amount.

The vaccine will be 10 micrograms, a third of the amount given to 12 or older.

Kids in the younger age group will also receive two shots, with 21 days in-between.

The decision came after unanimous voting by a CDC advisory committee, followed by CDC Director Dr. Rochelle P. Walensky’s endorsement.

“We know millions of parents are eager to get their children vaccinated and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine. [A]s a mom, I encourage parents with questions to talk to their pediatrician, school nurse, or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated.”
– CDC Director Dr. Rochelle P. Walensky

The Food and Drug Administration (FDA) authorized the vaccine for kids last week.

The rollout of the vaccines has begun and is expected to be fully up and running by next week.

Still, with the announcement, many parents with children closely approaching 12 years of age have been left in a tight spot, wondering whether it is smarter to wait a few weeks or months for their kids to turn 12 and get a full dose of COVID-19 vaccines or to get the pediatric dose.

Here is what experts have said:

A review of CDC data showed that getting vaccinated reduced the chances of becoming severely ill or hospitalized by 10 times and contracting the virus by 5 times.

Unvaccinated Americans were also 11 times more likely to die from the Delta variant.

Amichai Perlman, PhD, PharmD, pharma domain expert at K Health, said that waiting to get vaccinated could increase a child’s risk of becoming sick with COVID-19.

Although kids are less likely to experience COVID-19 complications and not become as sick, since the spread of Delta, pediatric COVID-19 cases have risen fivefold over the summer.

More than 8,300 kids ages 5 to 11 have been hospitalized due to COVID-19, with a third requiring intensive care, according to U.S. data. Ninety-four children have also died. The coronavirus is a top 10 cause of death for children in this age group.

It is also impossible to predict which children will become sicker or recover quicker from COVID-19.

“The reason I would not wait is that they may get a COVID-19 infection while they are waiting. It’s better to give them the smaller dose and have their body prepared for future exposures now, rather than wait for a larger dose later and risk infection in the meantime,” said Dr. Sarah Bosslet, a primary care pediatrician at Riley Children’s Health.

An FDA review showed that 2 doses of the 10 microgram dose had a 91 percent efficacy rate. The review was based on data from Pfizer’s trial, which monitored 2,268 children.

No unexpected side effects or safety concerns were reported in younger children.

The most common side effects kids complained of were fatigue, pain at the injection site, and headaches.

Perlman said parents should not be worried about using the recommended dosage for their children.

“The Pfizer vaccine has been found to be safe and effective at preventing COVID-19 in the doses tested [for children],” he said.

The smaller dose proved to be better in some aspects.

“The trials found that in children aged 5-11, the lower dose (10 micrograms) produced similar levels of antibodies as the full dose in adults, caused fewer side effects, and provided high protection from COVID-19.”
– Dr. Amichai Perlman

The age divide is not as clear-cut as most think, but it has to do with how the immune system works.

“There are some changes in the immune system with age, though it would be difficult to pinpoint a specific cut-off predicting the effect of dose by age. Clinical research is therefore done using age groups that represent different stages of growth, and provide us with ‘hard data’ on the expected results of vaccination in each group and guide treatment by age,” explained Perlman.

“[Scientists] found for 11-almost-12 year-olds the lower dose worked well. The dose is based on immune system maturity, and waiting a few weeks for the larger dose is not necessary,” said Bosslet.

Perlman said that the exact impact the different doses had in terms of long-term efficacy and very rare side effects (like myocarditis) is still unknown. “The data to date shows both doses are very effective and have good safety when given in the appropriate age group,” he said.

Bosslet also noted that parents should be aware that their kids will have to get the same dose of the COVID-19 vaccine for both doses, meaning that if they turn 12 in the interim, they will not get an adult dose for the second shot.

When choosing the dosing of the COVID-19 vaccine for kids, the only metric that matters is age, experts say.

So, your child’s height or weight will not determine whether they get a microdose or the full dose.

Perlman underlined that dosing was not height or weight-dependent, unlike the painkiller paracetamol (acetaminophen) or some antibiotics.

“The vaccine acts at the injection site by stimulating an immune response. This response affects the body as a whole and is not expected to be dependent on body size. In the clinical trials, the dose of the vaccine was not adjusted to children’s weight or height,” he said.

The only exception to kids who should not get the Pfizer vaccine is those who have had a severe allergic reaction (anaphylaxis) or an immediate allergic reaction to the ingredients in the Pfizer-BioNTech COVID-19 vaccine. One such ingredient is polyethylene glycol.

Those with children younger than 5 years old will also have to wait until a formal decision comes. Currently, a 3 microgram dose is being tested in trials.

Bosslet said it was OK for people to receive multiple vaccinations during the same visit.

A U.K. study, for example, found that having a flu vaccine and the second dose of a COVID-19 vaccine at the same time was safe.

As the case was with the flu vaccine, the injections may be given in different arms to see if one causes a local reaction.

“According to the CDC, the COVID-19 vaccine can be given simultaneously with other routine vaccines, as this is not expected to impact their safety and efficacy,” said Perlman.

If parents have any concerns, they should contact their healthcare professionals to decide what is best, said Perlman.

“Some vaccines have more side effects than others, and you may want to separate them. However, it is important to ensure you don’t miss the routine vaccines,” he added.