COVID vaccine FAQs

Key questions about vaccines for children

Why should children get vaccinated against COVID-19 if kids’ symptoms are typically mild?

While severe illness due to acute COVID-19 infection is less frequent in children compared to adults, hundreds of children have been admitted to CHEO with COVID-19 since December 2021. More than half of them have been under 5. Some children can also develop other complications from COVID-19 beyond the infection itself, including a condition called multisystem inflammatory syndrome (MIS-C). While highly treatable and rare, approximately one in three children hospitalized with MIS-C will require intensive care. Further studies will be needed to assess how well the vaccines protect against all of COVID-19's worst effects.

Is there any chance that the COVID-19 vaccine can give me the virus?

No. There is no way you can get COVID-19 from any of the vaccines. None of the vaccines contain the SARS-CoV-2 virus, which causes COVID-19.

Is vaccination safe for children with food allergies?

Yes. There is no reason a child with a food allergy of any kind should not be vaccinated. Children with a history of allergy to foods, oral drugs, insect venom or environmental allergies can receive COVID-19 vaccines without any special precautions. If you are concerned about the possibility of an allergic reaction to any of the vaccine ingredients or a previous dose of the vaccine, please consult your child’s primary health-care provider.

What is the difference between natural immunity and immunity from the COVID-19 vaccine?

Natural immunity refers to the immune responses that are developed following exposure to an infection. When contracting an infection, most individuals will develop antibodies that are key to recognizing and fighting the same infection, if encountered again.

Natural immunity can decrease with time, and the antibodies may not last in your immune system for a very long time. Developing natural immunity also implies that you need to contract the infection, meaning that you could experience very serious health complications as a result.

Immunity against COVID-19 can also be achieved by getting vaccinated. The difference, in this case, is that the vaccine instructs your immune system on how to develop the antibodies that protect against COVID-19 without having to contract the infection and get sick. Because additional vaccine doses are given to help build the immune responses, the antibodies continue to circulate in the body for a longer period than when contracting the infection a single time.

How can anyone be sure that vaccines developed so quickly is also safe?

Work on coronavirus vaccines has been ongoing for more than 10 years, due in part to the SARS-CoV-1 outbreak in 2003. It was important to develop the COVID-19 vaccine quickly because of how many people were dying and getting sick, and because of the disruptions to everyday life as a result of the pandemic. The response to the COVID-19 pandemic has drawn on all that previous work to allow medical scientist and public health-care officials to respond at an unprecedented rate. That said, all the usual steps for the approval of vaccines occurred, including clinical trials with the appropriate number of participants (including some from CHEO). Because of the large amount of resources that were made available to develop a COVID-19 vaccine and the large number of COVID-19 cases, the clinical trials were accelerated. This made it easier to tell quickly whether or not the vaccines worked to prevent cases of COVID-19. The vaccine was rapidly shown to be safe and effective in protecting against COVID-19.

What about reports of vaccine side-effects like myocarditis and pericarditis in younger people?

Myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the heart’s outer lining) are rare and most commonly experienced by older adolescents and young adults. Both are extremely rare in relation to the COVID-19 vaccine. More than 10 million children in the U.S. and Canada have received the vaccine with very few reports of these conditions. Myocarditis and pericarditis actually occur far more often after COVID-19 infection than after being vaccinated against COVID-19, as noted by Health Canada and the Centers for Disease Control and Prevention. There are multiple surveillance mechanisms in place in order to monitor any potential post-vaccination risk of these conditions over time.

Can the COVID-19 vaccine affect puberty or fertility in children?

There is no evidence or scientific reason to believe that the COVID-19 vaccine can affect puberty and fertility in children. Clinical trials of those who have been vaccinated in the general population have shown that the vaccine is very safe.

Does the vaccine work against the Omicron variant? Will it work against other variants?

The Omicron variant is known to be much more transmissible than previous strains of COVID-19 but vaccination still protects against serious illness and hospitalization. The more people who are vaccinated against COVID-19, the more we can protect ourselves and prevent new variants from emerging and spreading in the community.

Where can I find vaccination resources for Indigenous children and families?

Seeking out culturally relevant resources is key to making decisions about vaccination. The National Collaborating Centre for Indigenous Health has a webpage on COVID-19 updates, including information on COVID-19 vaccines. The Indigenous Education Network and Ontario Institute for Studies in Education (OISE) Library have put together an Indigenous COVID-19 Information and Resource page, which contains information on vaccine resources and Indigenous COVID-19 vaccination centres.

My child is afraid of needles. What can I do to help?

Some children have a very strong reaction to needles. If your child is worried about getting a needle, you can ask for special ways to support their vaccination, such as a longer appointment time or a private space for the injection. Comfort Care and the CARD system (Comfort, Ask, Relax, Distract) may also help. They provide strategies to reduce the pain, stress and worries associated with vaccinations and other procedures to make the experience a positive one. For children worried about pain, there are numbing creams and patches available at many pharmacies to help minimize needle discomfort.

What can I do for my child who is sensory-sensitive?

Sensory-sensitive vaccination clinics use some of the Comfort Care and CARD strategies listed above to offer a calmer environment for each child, giving them as much time as they need and their own room to get the vaccine. Some clinics also offer sensory-sensitive appointments, offering dimmed lights, less noise and a slower pace, as well as privacy.

What is the current evidence for vaccination for COVID-19 in children with disabilities or medical complexity?

Current evidence suggests that children with disabilities or medical complexity may be at an increased risk for severe illness or complications from COVID-19 based on their underlying condition making vaccination and prevention of COVID-19 especially important. All approved COVID-19 vaccines are safe and effective for children with a wide variety of different medical conditions and complexities. Unexpected or severe side-effects to the vaccine are very rare. If you have specific questions about your child’s medical condition and the COVID-19 vaccine, talk with your child’s doctor or book an appointment with the SickKids COVID-19 Vaccine Consult Service.

What special considerations are there when vaccinating children with disabilities or medical complexity? Where can family caregivers find additional resources?

Families should consider different strategies that have worked well with previous immunizations and create a plan to set their child up for success. Some questions to consider when scheduling your child’s vaccination appointment include:

Does my child require a calmer environment? (i.e., privacy, quiet)
If applicable, is the vaccination clinic wheelchair accessible?
Which distraction techniques are typically most effective for my child (i.e., deep breathing, counting, watching a favourite video, stress balls)
What position will be most comfortable for my child during their vaccination (i.e., comfort holding, sitting with caregiver, lying down)

If family caregivers have questions related to vaccinating their child with disabilities or medical complexity, you should first reach out to your child’s primary care physician.

For additional questions after speaking with your child’s physician, you can book an appointment with the SickKids COVID-19 Vaccine Consult Service.

I cannot decide if vaccinating my child is the right thing to do. Who can I talk to?

Contact your child’s primary care provider or the SickKids COVID-19 Vaccine Consult Service, a by-appointment phone service for Ontario residents that provides a safe, judgment-free space to have an open conversation about the COVID-19 vaccine with a pediatric registered nurse.

Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558.

For general information on COVID-19, please visit the COVID-19 Learning Hub.

How can I get my vaccination receipt?

After each dose of the COVID-19 vaccine that you get, you will be able to log into Ontario's provincial portal to download and or print an electronic COVID-19 vaccine. If you have a red and white health card, call the Provincial Vaccine Booking line at 1-833-943-3900. You will be emailed a copy of the vaccine receipt after your request.

Anyone who does not have a health card but was vaccinated in Ontario and needs proof of vaccination, can call 613-691-5505 and listen to the options.

Questions about vaccines for infants, toddlers and young children (ages 6 months to 5 years)

I have a child between the age of 6 months and 5 years old. Should they get the vaccine?

Dr. Anne Pham-Huy says, “Yes!” She’s an infectious diseases physician at CHEO and a member of the National Advisory Committee on Immunization (NACI). “If I had a child under 5 years old, there’s no doubt I would make sure they got their vaccine. I’d expect them to catch COVID at some point, but I’d rather not have them go through it without any kind of protection.”

What do we know about the Moderna vaccine for kids under 6?

Clinical trial findings show that Moderna’s vaccine, which is 25 micrograms (half the dose given to the age 6 to 11 group), produces an immune response in children under 5 equal to the immune response seen in young adults 18 to 25 years of age who receive the 100-microgram dose primary series. Preliminary efficacy of the vaccine in preventing symptomatic COVID-19 when Omicron is the dominant variant is estimated at 50.6% in children 6 to 23 months of age and 36.8% in children 2 to 5 years of age, starting 14 days after the second dose. However, vaccine efficacy against severe disease is likely much higher.

More information is available in this summary document from the National Advisory Committee on Immunization.

What is the risk to children under 5 years old from COVID-19?

With the spread of the Omicron variant, there have been more cases of children under age five in hospital with COVID-19 than earlier in the pandemic. CHEO, for example, has admitting more the 245 kids with COVID-19 since December; more than half of them were under 5.

Neonates are more at risk of hospital admission because they have an immature immune system that has difficulty combatting disease.

Children who have had COVID-19 are at risk of experiencing multisystem inflammatory syndrome (MIS-C), a rare but serious complication that usually requires hospitalization. Children who have an underlying medical condition are at higher risk of severe outcomes from COVID-19. Severe disease and MIS-C can occur in any child, whether they have an underlying condition or not.

Further, all individuals can help protect vulnerable members of their family, including children and youth, by ensuring that they and everyone around them are vaccinated against COVID-19.

Read the full Advisory Committee Statement from NACI for more information.

Is there a choice of vaccines like adults have?

For children under 5, the only approved vaccine is Moderna. A vaccine developed by Pfizer is currently under review by Health Canada and a decision is expected in the coming weeks to months. For children who are 5, there are now two approved vaccines, Moderna and Pzifer.

Should I wait for the Pfizer vaccine?

If you have decided to vaccinate your child, we encourage you to get the first vaccine that is available. There is no reason to wait.

Do children aged 6 months to 5 years need one vaccination or two? Is a different vaccine dose used in younger children?

For the Moderna vaccine (children 6 months to 5 years), there is a two-dose schedule with each dose being 25% of the adult dose. This dose showed similar immune response in the young children as with adolescents and adults. The National Advisory Committee on Immunization (NACI) recommends that the second dose should be given at least eight weeks after the first dose.

Children aged 5 years may receive a two-dose schedule of a smaller Pfizer vaccine dose than the one used in people 12 and older (10 µg instead of 30µg). The National Advisory Committee on Immunization (NACI) recommends that the second dose should be given at least eight weeks after the first dose. Children who turn 12 before their second dose may receive an adult dose.

How effective is one dose of the vaccine against COVID-19?

The COVID-19 vaccine is currently a two-dose series for children aged 6 months to 11 years. While one dose provides partial protection in young individuals, it takes both doses to be considered fully vaccinated and optimize the protection provided by vaccination.

How long do children have to wait between their first and second dose of the COVID-19 vaccine?

Canada’s National Advisory Committee on Immunization (NACI) recommends children aged 6 months to 11 years receive first and second doses eight weeks apart as this interval is expected to be more beneficial for children in terms of producing longer-lasting immunity and fewer side-effects. While this is NACI’s recommendation, in some cases, the second dose may be administered with a minimum of 21 days between the two doses, as per Health Canada approval. This shorter interval may be considered if informed consent is provided by the child’s caregiver, recognizing the risks and benefits of receiving the second dose earlier than the recommended eight weeks.

What are the side-effects in children aged 6 months to 5 years?

The Moderna vaccine is well tolerated in children less than 6 years of age with side-effects generally comparable to the adolescent and adult age groups. These may include feeling tired, chills, muscle aches and pains and a sore or red arm. The majority of children had very mild side-effects or none at all. Typically, these side-effects will go away after a few days and there are no long-term side-effects reported. Side-effects were also comparable to other childhood vaccinations.

If Moderna has a higher risk of myocarditis youth and young adults, why should I now trust that it’s safe for children under 6?

In the vaccine trial for children under 6 years of age, there were no reported incidents of myocarditis.

I’m nursing my baby. Are there any considerations?

All available COVID-19 vaccines approved in Canada can be used during pregnancy and breastfeeding. Presently, preference is given for the use of mRNA vaccinations during pregnancy as more data on safety and efficacy during pregnancy is available for these vaccines. See the Statement on COVID-19 Vaccination in Pregnancy from the Society of Obstetricians and Gynaecologists of Canada.

Although breastfeeding provides some benefit, providing a COVID-19 vaccine to an infant is the best way to protect them against COVID-19 disease.

My child is 5. Should I be concerned about the lower Moderna dose not being as effective as the Pfizer dose for kids aged 5 to 11 years?

There has been no study comparing Pfizer and Moderna products in this age group. The Moderna trial showed that, at the 25-mcg dose, the immune response in children under 6 years was the same as for adults. NACI has recommended offering the Pfizer product in children aged 5 years given the relatively larger experience with this product.

If my child has had COVID-19, should they get vaccinated? How long should they wait?

Yes. It is recommended that anyone who has had COVID-19 should still get the vaccine.

The clinical trials included people who previously had COVID-19 and the vaccine was found to be safe for them. Because it is not known how long antibodies against COVID-19 last after infection and it is possible to get the infection again (sometimes more severely), the vaccine is recommended as it can be helpful in boosting a person's existing immunity to COVID-19.

The National Advisory Committee on Immunization (NACI) suggests an 8-week interval between infection and initiation or completion of a COVID-19 primary series (i.e., 8 weeks after symptom onset or positive test if asymptomatic). This interval may be shortened for children considered moderately to severely immunocompromised (e.g., 4 to 8 weeks after symptom onset or positive test if asymptomatic).

I am behind on my child’s routine vaccinations. Can I get my child’s routine vaccinations at the same time as their COVID-19 vaccination?

Since the COVID-19 vaccine is new in this age group, The National Advisory Committee on Immunization (NACI) is recommending that other vaccines should not be given at the same time as the COVID-19 vaccine, and to wait 14 days between vaccines.

I am behind on my child’s routine vaccinations. Should I get the COVID-19 vaccination first and then get up to date?

This is a personal decision and can be discussed with your primary care provider based on risks. For young children, their primary immunization series are important, however during a COVID-19-related surge in the community, one might prioritize the COVID-19 primary vaccine series.

Is there a vaccine for infants under six months of age?

No. A vaccine for this age group would require clinical studies to determine the safety and benefits of vaccination. However, babies can receive protection through immunization of the parent during pregnancy and subsequently through breastfeeding.

How can I protect my unborn baby from COVID-19?

If you are pregnant, your vaccination is the best way to protect your baby from COVID-19. Vaccination enables you to pass on immunity to your baby while also protecting yourself.

Does this immunity offer protection after the baby is born?

Yes, it is well-recognized in other infectious diseases, such as flu and whooping cough (pertussis), that antibodies resulting from vaccination in a pregnant person provide protection for the first six months of an infant’s life. Multiple studies, including this from the U.S. CDC, have also shown that infants born to those who are vaccinated have more antibodies against COVID-19 and are less likely to be admitted to the hospital with COVID-19. If the pregnant person has not been vaccinated or infected, the baby does not have the protection of antibodies transferred from the parent during the third trimester of pregnancy.

I cannot decide if vaccinating my child is the right thing to do. Who can I talk to?

Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558.

Other resources

Kids #Under5 Vaccines (Science Up First)
COVID-19 vaccination for ages under five (AboutKidsHealth.ca)
Max the Vax (Canadian Medical Association, Children’s Aid Foundation of Canada)
Comfort Care (CHEO)

Questions about vaccines for children aged 5 to 11 years

Do children aged 5 to 11 need one vaccination or two? Is a different vaccine dose used in younger children?

Children aged five to 11 receive a two-dose schedule of a smaller Pfizer vaccine dose than the one used in people 12 and older (10 µg instead of 30µg). The National Advisory Committee on Immunization (NACI) recommends that the second dose should be given at least eight weeks after the first dose. Children who turn 12 before their second dose may receive an adult dose.

For the Moderna vaccine in children 6 months to 5 years, there is a two-dose schedule with each dose being 25% of the adult dose. This dose showed similar immune response in the young children as with adolescents and adults. The National Advisory Committee on Immunization (NACI) recommends that the second dose should be given at least eight weeks after the first dose.

What are the vaccine side-effects in children aged 5 to 11?

Clinical trial data show that the vaccines are well tolerated in children aged 5 to 11 years old, with side-effects generally comparable to side-effects your child may have experienced after other childhood vaccinations. These may include feeling tired, chills, muscle aches and pains and a sore or red arm. The majority of children had very mild side-effects or none at all. Typically, these side-effects will go away after a few days and there are no long-term side-effects reported.

My child is turning 12 years old soon. Should I wait until they are 12 so they can get a larger dose?

The first COVID-19 vaccine that is available for your child will be the best vaccine to get, as it will provide protection against COVID-19 to your child as soon as possible. Vaccine doses are based on age and the maturity of the immune system. The clinical trials showed the paediatric dose given to children aged five to 11 (a third of the dose given to people aged 12 and up), was effective and also resulted in fewer side-effects.

If my child has had COVID-19, should they get vaccinated? How long should they wait?

Yes. It is recommended that anyone who has had COVID-19 should still get the vaccine.

What if my child’s weight is above average in their age group?

Vaccine doses are based on age and the maturity of the immune system, not weight. The clinical trials showed the paediatric dose given to children aged five to 11 (a third of the dose given to people aged 12 and up), was effective and also resulted in fewer side-effects, including in children with above average weight. Therefore, children who are almost 12 or weigh more than average would not benefit from receiving the adult dose.

How effective is one dose of the vaccine against COVID-19?

How long do children have to wait between their first and second dose of the COVID-19 vaccine?

I cannot decide if vaccinating my child is the right thing to do. Who can I talk to?

Book an appointment online at www.sickkids.ca/vaccineconsult or by calling 1-888-304-6558.

COVID-19 vaccine FAQs