As the COVID-19 vaccine is becoming available to younger children in the U.S. and other countries across the globe, and we learn more about recommendations for booster shots and the vaccine benefits for pregnant people, there are more than a few questions about what people—and parents—should do.

The decision to vaccinate your child, or to receive a vaccine while pregnant, can feel quite different than making that decision for only yourself. And as we continue to move together through this pandemic, information and health recommendations have evolved quickly as the data and evidence have grown. It’s a lot to keep up with, and understandable to feel challenged when making decisions for your family.

As we incorporate more information and reminders on routine childhood vaccinations into the Cleo App, we’re also making extra effort to keep members informed on the COVID-19 vaccine. As unequal access to information and disparities in vaccination levels persist, contributing to further health inequities, Cleo is committed to ensuring all members have access to evidence-based information.

To help translate all the current data and put it into context, Cleo’s Clinical team hosted a live webinar led by Chief Medical Officer and Cleo Co-founder, Dr. Chitra Akileswaran; Clinical Lead for Birth Outcomes, Dr. Rebekah Wheeler; and Clinical Lead for Neonatology, Dr. Nina Zelazny. They also shared an instructive framework for decision-making, including common trouble spots such as disagreement between partners. All of our presenters are not only healthcare experts, but parents as well, and they bring a very personal and human perspective to the discussion.

View the complete webinar recording (~60 minutes) which goes deep into everything we currently know about the vaccine’s safety and effectiveness and how to approach the decision-making process, and keep reading below for key highlights.

What we know about the vaccine’s safety and effectiveness

The COVID-19 vaccines approved or authorized in the United States are highly effective and provide the best protection against serious illness and death. They are not 100% effective, and some fully vaccinated people will become infected (called a breakthrough infection), so it’s helpful to understand vaccination in terms of risk versus benefit.

Although the vaccine arrived quickly, the same oversight was put into the release of this vaccine as is done in all other vaccines for children in the U.S. and as is customary, the outcomes from the COVID-19 vaccines will continue to be studied. In the case of the Covid vaccine, in each population so far—including children age 5-11 and pregnant or chest-feeding people—it has been determined that the risk from the disease is worse than the risk from the vaccine.

Note that even if someone has already contracted COVID-19, vaccination is still recommended. This is because immunity is difficult to predict, and we don’t yet know how long it may last. A study in adults showed that fully vaccinated people were 5 times less likely to be hospitalized with COVID-19 when compared to people who had had a previous infection.

As more people become vaccinated, outbreaks of COVID-19 should decrease as opportunities for the virus to spread diminish. When we protect ourselves and families, we’re helping protect others as well.

For young children (5-11)

While it is true that children have had fewer complications and hospitalizations from COVID-19, it still poses some considerable risk. About 700 children 18 and under have died in the U.S. since the pandemic began.¹ To put that in perspective, the average number of child deaths from the flu is less than 200 per year,² and annual flu vaccines are routinely taken to avoid severe cases and slow the spread.

Data from the Pfizer vaccine trial included children ages 5-11 from the U.S. as well as other countries. One group was given the vaccine (about ⅓ of the adult dose) and one group was given a placebo (or empty shot)—two doses, 21 days apart. There were about 2,200 children that received the COVID-19 vaccine.

Side effects typically included a sore arm and fatigue, headache, chills and fever and they tended to clear up in 48 hours. No serious side effects were seen in this trial. The manufacturer did indicate that there were not enough patients in this specific trial to detect very rare events such as myocarditis (inflammation of the heart muscle). Reporting will continue to be done going forward as millions of vaccines are given. While there was some concern with myocarditis in older children and adults, especially in young men, it’s important to keep in mind that COVID-19 as well as many other viruses—including the common cold—can also cause it. A recent study showed that the risk of myocarditis was more likely after having COVID-19 than after having the vaccine.³

Consult with your child’s doctor in case of any specific questions or concerns including:

• Recent illness with COVID-19
• Recent exposure to COVID-19
• Underlying health conditions

For pregnant and lactating people

COVID-19 infection poses added risks during pregnancy, and the vaccine has proven safe and effective among pregnant and lactating people. COVID-19 infection during pregnancy is linked with more severe illness in the pregnant person, and higher rates of miscarriage and preterm birth. In fact, being pregnant can be considered a high-risk condition with regard to COVID-19 for the following reasons:

• The immune system is not as strong during pregnancy (other viruses such as the flu are also worse in pregnant people)
• There is increased strain on the lungs, kidneys, and heart from the dual burden of pregnancy and infection
• There is a demonstrated link between fevers in pregnancy with miscarriage and preterm birth

There is also abundant information that the vaccine is safe while chest-feeding.⁴ There is even evidence that antibodies to COVID-19 are present in human milk, though we do not know yet how this translates to immunity for babies fed milk from a recently vaccinated individual.

Navigating the decision-making process

Every parent ultimately needs to weigh the risks and benefits of vaccination for their child. Waiting to get the vaccine should be weighed against the likelihood of exposure to COVID-19 during said waiting period. Keep in mind that from the time of the first dose, it takes about 5 weeks for full immunity to develop.

Other consideration to help in making your decision should include:

• Concern for underlying conditions in your child or other family members
• Degree of exposure that your child experiences in their routine activities
• The types of activities your family would like to plan for in coming months, including holiday celebrations and travel

If you find yourself on the fence, the following can help in reaching a decision:

• Frame the question of vaccination more specifically. “Will we do it or not?” is too vague, but “Will we do it ASAP or wait one month?” gives you more of a framework.
• If not doing it now, identify your conditions to reevaluate. Under what circumstances will you revisit? When one month of data is released? When you know that you’re visiting high-risk relatives? When a mandate comes into effect?
• Set a time in your calendar to revisit.

What if my partner and I don’t agree

In the case of disagreement over the vaccine it is most helpful to hone in as specifically as possible on the area of concern: What is the specific worry and what can be done to learn more about it and move forward with a decision? Identify a reliable source of information, ideally a healthcare provider, with whom to discuss these concerns and get answers. And just as with one’s self, set a timeline and conditions for reevaluating and making a decision.

If this, or other similar decisions continue to be a sticking point, Cleo members can ask their Guide about connecting with a co-parenting specialist.

What if my child is afraid of needles?

Children (and adults) are understandably less than thrilled about getting shots. How to approach this will differ by the age of your child, but generally speaking, being direct and honest about the expectation and reason for the vaccine will help build trust. The shot goes quickly, and often the stress of anticipation is the worst part, so consider this when deciding how far in advance to begin discussing.

Giving your child some aspect that they can control is also helpful—”do you want to go to the playground on the way there, or after?” Let them bring a favorite comfort toy, squeeze your hand, use headphones with music or another distracting device or book. And vaccines are an occasion such that an incentivizing reward—think ice cream or other treats, or even a new toy—is more than okay.

Who should consider a COVID-19 vaccine booster and why

The vaccine works in two ways. It creates antibodies that fight and prevent infection, which fade over 1-6 months. And it also creates a memory for how to fight the infection which stays much longer, but we don’t yet know how long. This memory of how to fight the infection only works to decrease the risk of severe infection rather than preventing illness entirely. So for those at higher risk for a severe infection, it’s important to “boost” their antibodies which are the first and strongest line of defense. It also decreases the opportunity to carry and spread COVID-19 to others.

A vaccine booster is now recommended for anyone age 65 or older, and anyone 18 and older with a high-risk condition (including pregnancy) or high-exposure living or work environment (like healthcare workers and teachers).

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¹https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Focus-on-Ages-0-18-Yea/nr4s-juj3/data
²https://www.cdc.gov/flu/spotlights/2019-2020/2019-20-pediatric-flu-deaths.htm
³https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm
⁴https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html

Note: This content has been reviewed by Dr. Chitra Akileswaran, Cleo’s Chief Medical Officer and Co-founder. Cleo aims to give the most accurate information, but details and recommendations may have changed since this piece was published. For the latest information, please check out resources from the World Health Organization, U.S. Centers for Disease Control, and local public health departments.