By Sandee LaMotte, CNN
It’s what parents around the country have been waiting for: Pfizer and BioNTech announced Thursday they are asking the US Food and Drug Administration for an emergency use authorization for their Covid-19 vaccine for children ages 5 to 11.
It may take some weeks for the data to make its way through the FDA’s protocols and be green-lit for use in children by the agency and then the US Centers for Disease Control and Prevention.
In the meantime, parent’s minds are already buzzing about how to make plans for their child to get a shot and what to tell them about the experience.
CNN reached out to pediatrician and child development expert Dr. David Hill to ask him questions that parents — and kids — will want answered. Hill is the former chair of the American Academy of Pediatrics Council on Communications and Media, and is currently a co-host on the AAP’s flagship podcast, “Pediatrics on Call.”
This conversation has been lightly edited for clarity.
CNN: Do you think children between the ages of 5 and 11 will be overly concerned about getting the Covid-19 vaccine?
Dr. David Hill: As far as kids are concerned, this is just one more vaccine, one more shot. How they react is going to be very largely — if not completely — dependent on how the adults in their lives frame the experience. If we are expressing concern, skepticism or worry, they’re absolutely going to pick up on that. If we’re expressing confidence and relief, they’re going to pick up on that as well. And children are always listening, even when we think they aren’t.
Kids always want to know, “Am I going to be OK?” As parents, we need to be able to give them honest and reassuring answers. The data on the dose for 5- to 11-year-olds is not out yet to be scrutinized, but based on our experience with the other vaccines, we hope we’re going to be able to say, “Yes, this is very safe, and yes this will keep you from getting sick.”
CNN: As a pediatrician, what do you think is a child’s biggest fear about getting a vaccine of any kind?
Hill: By far the No. 1 thing that I hear is, “I don’t want this to hurt. How bad is it going to hurt?” First, I never lie to kids. I never tell them it’s not going to hurt at all or you’re not going to feel it, because it’s just not true.
You want to be honest. You want to say, “You know what, it’s going to hurt just a little bit, but it’s not going to hurt as bad as some other things that happen to you all the time — like falling down when you’re running or stubbing your toe.”
Then, you want to give children a sense of control, a sense of power, a sense that they are doing something that matters. Talk about what they can do: “You like to play baseball and you’re right-handed, right? Maybe you want to have the shot in your left arm instead of your right.”
Talk in advance, too, about what they can do so that they don’t notice the pain: “Do you know that if you take a breath and blow out really slowly things hurt less? They also hurt less if you’re singing or if you’re holding my hand.” There are a lot of things that you can do, from distraction to breathing to thinking pleasant thoughts to talking about something else. All these things make a difference.
If you can reassure children that yes, you’re going to have control, and yes, it’s going to hurt a little, but we’re going to help you keep it from hurting as much as you think, those things can be very helpful.
CNN: Kids want to know whether they can go on playdates with their friends, visit their grandparents over the upcoming holidays and take pictures with Santa. Do we know yet if that will be possible for vaccinated children?
Hill: Much of the answer to that question is going to depend on how the entire community responds. When community transmission rates are very low, a lot of things become very safe. It will also have to do with how effective the vaccines for children are, but it will probably have more to do with how many people get the vaccine and how much care we take with distancing and keeping our masks on, until we get these numbers down so low that the general risk is within a tolerable number.
I certainly hope that over time, we’re going to see that these vaccines in younger children are super effective, so effective that we can stop taking other precautions. But I think it will really depend on everybody doing their part and squashing this virus to just a point where it’s no longer a major threat.
CNN: Will children be able to stop wearing masks at playdates if everyone present is vaccinated? What about at school?
Hill: I don’t think we will be able to forgo masks until this virus is more tightly controlled. Right now, we are seeing with the transmissibility of the Delta variant that even vaccinated people can get Covid-19. The vaccine is extraordinarily successful at preventing people who have received it from being hospitalized or from dying from Covid, but it is certainly possible to get a post-vaccine case of the virus.
If you are outside of the family unit or at a small space indoors, you do want to wear a mask. And that is what we are doing now, even if you are vaccinated. There was that brief moment before the Delta variant when community transmission rates were really plummeting, and the protection of the vaccine seemed to be high enough so that if you were with another fully vaccinated person, you could drop your mask.
Delta changed all that and sent us backwards, as did this third wave where the virus was becoming very prevalent in the community again. And so we had to step it back a little bit there and go back to using masks.
For the moment, I think the masks are still the rule, but that depends again on community rates of transmission. When community rates get low enough, hopefully we will all rip our masks off and go back to sitting close together in small spaces.
CNN: So many people are vaccinated now — why should a parent consider giving their 5- to 11-year-old the Covid-19 vaccine?
Hill: We’re not looking at the same infection in 2021 that we had in 2020. Some of the beliefs we had about the dangers of Covid-19 in children a year to 18 months ago don’t apply today.
Early in the pandemic, it appeared that children were much less affected than older adults. Now we know children can get extremely sick from Covid-19. We are especially worried about children with underlying conditions, such as obesity, which is very common among United States children. Lung disease, asthma, heart disease and, of course, immunodeficiency, are all risk factors for more serious cases.
Fortunately, the number of children who have died is very low compared to the number of adults who have died, but a significant number have been hospitalized and placed into intensive care units. I have personally taken care of children who became critically ill and had to be transferred to the intensive care unit because of the effects of Covid-19.
We used to think that children didn’t spread much virus. Now we know children can be reservoirs of infection for families and that spread of the virus can occur very easily. Right now, children are 27% of all Covid cases in the US.
We know that Covid-19 can directly inflame the heart muscle — it’s called myocarditis. Now, there has also been a concern around one of the Covid vaccines in young adults, but the vaccine-induced myocarditis is extraordinarily rare and significantly less common than the myocarditis induced by catching Covid.
There is a syndrome that is specific to children, called multisystem inflammatory syndrome (MIS-C). And it seems to behave a lot like Kawasaki disease, which can cause life-threatening heart disease and prolonged and severe illness. It’s emerging now that most kids who are affected by this condition ultimately do well, but it can be a very long and very difficult process while they’re recovering.
As parents, we’re all trying our best to keep our kids safe in the best ways that we know how, and so we’re programmed to look out for anything that can harm them. But it’s still just part of human nature that we tend to hesitate when it comes to taking an action. We are much more suspicious of doing than we are of not doing. So if a parent feels uncertain, they usually default to not doing as opposed to doing.
Now, our scientists are constantly getting smarter and learning more. That is a strength, but it can be confusing for people who say, “Well, you flip-flop. You change your mind. I can’t trust what you tell me.” But science is a process of constantly learning. You get some early clues, and you work with those clues, and then you get better information and things change. Trust the process.
We know from the history of vaccines, and the history of the Covid-19 vaccine in adults and in children age 12 and older, that giving the vaccine is much, much safer than having your child get Covid-19.
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