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Since March 2020, when the pandemic shut down offices and schools across the country, many parents have worried about their children getting sick. And despite some progress, we’re still dealing with these fears more than a year later.

Part of why the pandemic is still lingering is that we do not yet have vaccines for everyone. And part of it is also because of vaccine hesitancy.

Children are not “little adults,” and they do have different reactions to illness, medication, and vaccinations — so it’s normal for parents to worry.

But there are also a lot of rumors when it comes to COVID-19, especially surrounding the side effects of vaccines, so it’s important to clear up any misconceptions and myths. Here’s what you need to know:

While it’s true that many kids don’t develop as severe of cases of COVID-19 as adults — and many might be asymptomatic — that does not mean they can’t get COVID-19.

In fact, as of October 2021, there has been over 6 million cases of COVID-19 in children since the pandemic began. In the last week of September 2021, children represented 26.7 percent — more than 1 in 4 — of reported weekly cases.

School-aged children between ages 5 and 17 and kids in daycare might even be at greater risk of contracting COVID-19 than other children because they’re more likely to be exposed to it on a day-to-day basis. This varies, of course, and may depend on policies the school has in place.

One study found that kids are 3.5 times more likely to have a COVID-19 outbreak in their school if the school does not have a mask requirement.

Illness severity

While only 1 to 2 percent of all child cases have led to kids being hospitalized (at least in the states that are actively reporting on cases), 1 in 3 of those kids that have been hospitalized have required intensive care, according to the Centers for Disease Control and Prevention (CDC).

Intensive care often requires the use of ventilators, or machines that essentially do the work of breathing for you by manually pumping air into and out of your body.

It appears that babies under age 1 face the highest chances of developing severe symptoms, as do kids who have underlying conditions such as diabetes, sickle cell disease, or immunocompromised conditions who already have a higher chance of developing COVID-19.

However, there was a 10-fold rise in hospitalization rates among kids ages 0 to 4 years during the period of June to August 2021.

Taken altogether, kids and adolescents under age 18 saw a 5-fold rise in hospitalization rates, with rates among those who are unvaccinated being 10 times higher than those among the fully vaccinated. This roughly coincides with the rise of the Delta variant.

Children can also die from COVID-19, though the American Academy of Pediatrics doesn’t consider it to be common. Kids represent less than 1 percent of the total COVID-19 deaths in the United States.

Children can transmit SARS-CoV-2, the coronavirus that causes COVID-19, just like adults — and even when they’re asymptomatic.

“Children spread disease similar to adults via respiratory droplets containing the virus,” explains board-certified pediatrician Dr. Pierrette Mimi Poinsett. “The virus is airborne and transmitted via the inhalation of respiratory droplets containing the virus.”

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As of writing this article, the Pfizer-BioNTech vaccine is available for children 12 years and older. It’s been fully approved by the Food and Drug Administration (FDA) for children and adults ages 16 and over and has emergency use authorization (EUA) for children between ages 12 and 15.

Clinical trials have been underway for children between ages 6 months and 11 years old. The one for children ages 5 to 11 is complete, with its data from phases two and three showing the vaccine to be safe and effective.

In fact, Pfizer submitted its initial data to the FDA in September 2021 for this age group and requested emergency use authorization the next month.

Moderna is doing vaccine clinical trials for children and adolescents, and Johnson & Johnson is studying vaccine use in adolescents.

Not everyone gets side effects, and some kids won’t get any at all.

But if your child does experience side effects, they’ll be similar to those seen in adults. These side effects can include:

  • soreness at the injection site
  • fatigue
  • headaches
  • chills
  • muscle aches
  • fever

These side effects are usually temporary and should go away in about 48 hours.

There are two additional, very rare side effects that have been reported since April 2021: myocarditis and pericarditis.

Myocarditis is an inflammation of the heart muscle, or the myocardium, which can affect the heart’s ability to pump blood around the body.

Pericarditis is an inflammation of the two-layered sac-like structure that surrounds the heart, also known as the pericardium. These two layers always have a small amount of fluid between them to reduce friction, but when those layers get inflamed, it can cause chest pain.

The hallmark symptoms of these conditions are:

  • chest pain
  • shortness of breath
  • heart palpitations

If your child has any of the symptoms of myocarditis or pericarditis, seek immediate medical care.

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These rare side effects tend to be most common in males, particularly adolescent and young adult men.

But it’s important to know that “there is a greater risk of myocarditis with COVID-19 disease compared to COVID-19 vaccination,” says Poinsette.

Specifically, a study found that myocarditis in the young adult male population occurs in up to 450 per million COVID-19 cases but only about 76 per million vaccine recipients. It’s important to note that this research is currently in preprint, meaning it hasn’t yet been peer reviewed and shouldn’t be used as the basis for clinical guidance.

You can give your child a pain reliever after the COVID-19 vaccine, especially if they’re feeling side effects like soreness or aches.

But “there is no need to pretreat with a pain reliever,” says Poinsette. “There is no evidence that pretreatment will decrease side effects.”

“Vaccination is important in stemming the tide of the pandemic,” explains Poinsette. “Even children with mild disease transmit the disease to others.”

Kids who are not vaccinated are also still at risk for serious COVID-19 illness, even if that risk is lower than in adults and even if they don’t have an underlying medical condition.

In fact, according to the CDC, teenagers between the ages of 12 to 17 who have not been vaccinated have a 10 times higher rate of hospitalization compared with teens who have been vaccinated.

On August 23, 2021, the FDA approved the Pfizer-BioNTech vaccine for everyone ages 16 and older because the vaccine is both safe and effective at preventing the coronavirus infection that causes COVID-19.

The FDA has also granted emergency use authorization for children ages 12 through 15 because the clinical trial data showed the vaccine to be safe and effective.

So far, these vaccines have been given to millions of Americans, and they have helped protect people from severe infection, hospitalization, and death. To truly end the pandemic, vaccines are the most powerful tool for doing that and keeping people safe.