Physicians Address Parents’ Concerns on COVID Vaccines in Young Kids

Physicians answered questions from their peers and parents on how to approach concerns around vaccinating the youngest children against COVID-19, during a webinar hosted by the COVID-19 Vaccine Education and Equity Project on Wednesday.

Roughly 862,000 children ages 6 months to 4 years have received at least one COVID vaccine dose, said Sarah Meyer, MD, MPH, chief medical officer of the CDC’s National Center for Immunization and Respiratory Diseases. (The American Academy of Pediatrics puts this number closer to 1 million as of August 10.)

In either scenario, those numbers represent only about 5% to 6% of children in this age group. Vaccine uptake has been lower in children, even among those ages 5 to 11, than among adolescents and adults.

Among parents who were surveyed just before vaccines were authorized for children 6 months to 4 years, only about half said that they “definitely” or “probably” would vaccinate their child, Meyer said. The remaining parents either felt “unsure” or said they “definitely” or “probably” would not get their kids vaccinated.

“I think what this shows us is there’s still a lot of parents out there who want to get their child vaccinated, are intending to get their child vaccinated, and then there’s some that are on the fence,” she added.

Meyer urged clinicians to do everything they can to answer parents’ questions and to provide resources for support.

What can clinicians tell parents who want to “wait and see” how well the vaccine works in other children?

Many parents may have heard COVID is “not as serious” in children, Meyer noted, but during the Omicron surge, “we saw a lot of kids get infected,” with the youngest children having the highest rates of hospitalization.

When Edith Bracho-Sanchez, MD, a pediatrician at Columbia University Irving Medical Center-NewYork Presbyterian Hospital in New York City, hears from parents who want to “wait and see” how well the vaccines work, she said she makes an effort to respect their fears.

“I understand you’re trying to make a good choice,” Bracho-Sanchez said she tells parents. “But what are we waiting for? Are we waiting for more safety data? Because at this point …. we have millions and millions and millions of adults, teenagers, and children in this country and around the world who have received this vaccine safely.”

She explained that she will ask parents how long they plan to wait and encourages them to set a deadline for making a decision. In some cases, this strategy has worked.

“Some families have said, ‘You know what, why don’t you give me an appointment in a month. I’m going to gather all my information and … if I don’t feel good about it, I’ll call you,’” she noted.

Does a mother who has been vaccinated against COVID-19 and is breastfeeding also need to vaccinate her child?

There are some “encouraging” data showing that babies of mothers who were vaccinated during pregnancy have lower rates of hospitalization while they’re young, Meyer said.

There is also some research showing that antibodies can pass from the mother to baby while breastfeeding, but researchers still need more information to know whether these antibodies provide protection, she added.

“If your baby is 6 months or older, they really should get vaccinated, regardless of if you got vaccinated during pregnancy and including if you’re still breastfeeding,” Meyer noted.

Bracho-Sanchez said she got vaccinated against COVID-19 while she was pregnant and received her booster while breastfeeding, hoping to pass some of her own antibodies onto her son.

“The last step was to get him vaccinated, so that he makes his own antibodies … because me passing my antibodies [on to him] is great, but they only last him so long,” she explained.

How can clinicians respond to parents who believe COVID vaccine conspiracy theories?

“The biggest thing is to recognize the things that are concerning to our patients … are real. They may seem like a conspiracy theory, because we as scientists know that this is not true, but they’re real to those patients,” said Ada Stewart, MD, board chair of the American Academy of Family Physicians.

Stewart said that she listens to her patients and tells them what is actually true, pointing them to credible sources to verify the information.

“The bottom line is to recognize that vaccines are safe, they’re effective, and they save lives. We saw prior to the vaccines being rolled out how many people died from COVID-19. And we see now, even with the new variant, the Omicron variant, how many people who are vaccinated have mild symptoms and how they are no longer ending up in the hospital,” she noted.

Can children receive the COVID vaccine alongside their flu vaccine?

Stewart said that based on the scientific literature, there’s no interaction with other vaccines, including the flu vaccine.

In fact, she argued, this is a good opportunity for children, many of whom are behind on their primary vaccinations, to get caught up.

How long should a parent wait before vaccinating a child who’s recently had a SARS-CoV-2 infection?

There’s no specifically recommended waiting period before a child who’s had COVID can be vaccinated, Meyer said. However, children should no longer be in the acute phase of their illness and should also have finished their isolation period, she added.

“We don’t want them going out and maybe exposing others when they’re still sick … other than that, there’s really no minimum time you have to wait,” she noted. “You could consider waiting up to 3 months after infection to get vaccinated because what that does is it potentially helps your immune response to vaccination be stronger … and you’re probably not very susceptible to getting reinfection in that short amount of time.”

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