COVID-19 Vaccination in Children and Youth

Frequently asked questions

Risks of COVID-19 infection in children

• What risk factors are linked to severe COVID-19 infection in school-aged children?
  • Obesity
  • Medically fragile
  • More than one illness or disease
  • Neurological disorder
  • Immune dysregulation

  Even children without underlying medical conditions can also get seriously sick. According to the CDC in the U.S., almost half of children younger than 18 years old hospitalized with COVID-19 have no underlying conditions.

• What do I need to know about the risk of myocarditis (heart inflammation) and/or pericarditis (inflammation of tissue around the heart) after COVID-19 infection?

  Both myocarditis and pericarditis are more common after COVID-19 illness (a viral infection) than after vaccination.

  According to Kids Health First, myocarditis or pericarditis that occur following infections are often much more serious compared to the mild illness that has occurred following vaccination.

• What is Multisystem Inflammatory Syndrome?

  Multisystem inflammatory syndrome in children is a delayed inflammatory response to a COVID-19 infection. Multisystem inflammatory syndrome can affect children of all ages, from infants as young as one week to youth as old as 18 years.

  Symptoms may take two to six weeks following COVID-19 infection to appear and include:

  • Fever
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Skin rash
  • Other signs of inflammation

  The Canadian Paediatric Society states that 269 cases of MIS-C in individuals zero to 19 years of age have been reported in Canada as of Oct. 16, 2021. 58 per cent of cases occurred in children five years of age and older.

  According to the Public Health Agency of Canada's information on Canadian children with multisystem inflammatory syndrome:

  • Multisystem inflammatory syndrome is more likely to occur in males
  • Almost all cases required hospitalization
  • 36 per cent ended up in intensive care

  Watch Dr. Hirji (Acting Medical Officer of Health for Niagara Region) explain multisystem inflammatory syndrome in children.

• Can children get long COVID-19 after being infected?

  Yes, there is a possibility that children may be at risk of getting long COVID or a post COVID-19 condition. Current evidence suggests the risk is lower in children compared to older age groups.

  Watch Dr. Hirji (Acting Medical Officer of Health for Niagara Region) explain long COVID-19 in children.

• Are children at risk of newly diagnosed diabetes after a COVID-19 infection?

  A study by the CDC suggests there may be an increased risk of newly diagnosed diabetes in people 18 years of age and younger.

• What do I need to know about acute severe hepatitis in children?

  As of June 2, 2022, there are 12 cases of acute severe hepatitis in children in Canada, four from Ontario. At this time, the cause is not known.

  Adenovirus (a virus that causes cold or flu-like illness or gastronenetristis) is currently one of the possible causes being explored. The vast majority of children affected were too young to receive COVID-19 vaccination.

  Learn more about how Canada is investigating acute severe hepatitis in children.

• Can children die from COVID-19 infection?

  In Canada, 50 people aged zero to 19 have died from COVID-19 infection as of June 3, 2022.

  Watch Dr. Hirji (Acting Medical Officer of Health for Niagara Region) explain the data that shows how death from COVID-19 compares with other causes of death in children and how deaths from COVID-19 compares with other vaccine preventable diseases prior to the recommended vaccines.

Vaccine safety

Get more information on vaccine safety.

• How were COVID-19 vaccines developed so fast? What about the long-term safety?

  Get more information on vaccine safety.

• What do I need to know about reports of myocarditis (heart inflammation) and/or pericarditis (inflammation of tissue around the heart) and COVID-19 vaccination?

  Both myocarditis and pericarditis are more common after COVID-19 illness (a viral infection) than after vaccination.

  Reports of myocarditis / pericarditis after vaccination have been rare in Ontario and internationally. The risk may be even lower in children aged five to 11 years compared to youth and young adults (12 to 29 years of age).

  When it does happen, it seems to be:

  • Usually within a week after vaccination
  • More often after the second dose
  • More often in males
  • More often in youth and young adults

  The majority of cases have been mild, easily treated, and individuals recover quickly.

  An eight week interval between first and second dose may be linked with a lower risk of myocarditis and / or pericarditis in adolescents youth and young adults. This was one of the reasons why the National Advisory Committee on Immunization recommends an eight week interval between first and second dose for five to 11 year olds.

  The evidence on the risk of myocarditis / pericarditis after a booster dose is limited, but appears to be lower than the already rare risk after the second dose of the primary series but higher than after the first dose. Getting vaccinated and staying up to date provides personal recommendations by group.

  The National Advisory Committee on Immunization recommends:

  • Those who experienced myocarditis (with or without pericarditis) after a dose of mRNA COVID-19 vaccine should wait to get another dose until more information is available. However, some individuals may choose to receive another dose of vaccine after discussing risks and benefits with their health care provider.
  • Those who experienced pericarditis and either had no heart workup or had normal heart investigations, can receive the next dose once they are symptom free and at least 90 days has passed since their last vaccination
• What do I need to know about COVID-19 vaccines and fertility?

  According to the Society of Obstetricians and Gynecologists of Canada, there is no evidence or reason to suspect that the COVID-19 vaccine could impair male or female fertility.

  Learn more about the COVID-19 vaccines and fertility, pregnancy and breastfeeding.

• Where can I see the data showing how the vaccine is being monitored in Canada?

  Health experts closely monitor the safety of all vaccines, including the ones for COVID-19. Any potential safety issues are responded to right away and Canadians are informed of any potential risks that may arise.

  See Health Canada's weekly reports on the reported side effects following COVID-19 vaccination in Canada.

  See Public Health Ontario's Adverse Events Following Immunization for COVID-19 in Ontario.

General information

• What vaccines are approved for children five to 11 years of age?

  The Pfizer-BioNTech (Comirnaty) mRNA COVID-19 vaccine is the first COVID-19 vaccine authorized in Canada for use in children five to 11 years of age. This vaccine is designed specifically for the paediatric population. It is a lower dose (one-third the amount) compared to the adolescent/adult Pfizer vaccine for those 12 years of age and older.

• My child will be 11 years of age at their first dose appointment, but will be 12 years of age by the time of their second dose. Which vaccine will they get?

  The paediatric version of the vaccine will always be used for children five to 11 years of age at the time of vaccination. If a child is 12 years of age by the time of their second dose, their second dose will be the adolescent / adult version of the vaccine.

  Dosing is based on how an individual's immune system responds to the vaccine. For example, a small five year old and a large five year old have immune systems that respond to the vaccine in a similar way. The clinical trials show immune systems of children aged five to 11 respond similarly to the COVID-19 vaccine.

  It is both safe and effective for children to receive the paediatric version of the vaccine for their first dose and the adult/adolescent version for their second dose.

  Parents/guardians of children turning 12 soon should not delay getting their child vaccinated. Both the paediatric and adult/adolescent versions of the vaccine are safe and effective. Getting your child vaccinated as soon as they are eligible gives them the best protection against COVID-19.

• How does the COVID-19 vaccine fit in with scheduling other vaccines?

  COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines.

• What is the current information on COVID-19 vaccination in children under five years of age?

  Pediatric dose of Moderna for children six months to five years of age is currently under review by Health Canada. Learn how Health Canada reviews and authorizes vaccines.

• If children under five can't get vaccinated for COVID-19, how can we protect them?

  Vaccines add an extra layer of protection. It's important that all family members who are able to get vaccinated get their vaccine. This is one way to help protect children that are too young to get vaccinated.

  Visit COVID-19 advice for the community for personal actions you can take to keep your children safe.

Consent

• How can a parent or legal guardian give consent for their child?

  Consent for vaccination for children five to 11 years of age needs to be provided by a parent or legal guardian.

  It's preferred that children get their vaccine with a parent or legal guardian present at the clinic.

  If necessary, children can go with an alternative caregiver to get vaccinated. A parent or legal guardian must be available by phone to provide verbal consent and review health history.

  When COVID-19 vaccination clinics are being held at schools, they will take place outside of school hours. This is to ensure that parents or legal guardians can be with their children to provide consent.

  For those 12 and older, COVID-19 vaccines are only provided if informed consent is received from the person to be vaccinated and as long as they have the capacity to make this decision. This means that they understand:

  • What vaccination involves
  • Why it's being recommended
  • The risks and benefits of accepting or refusing to be vaccinated

  COVID-19 vaccination is voluntary for anyone eligible in Ontario. In Ontario, the Health Care Consent Act sets out certain rules on when consent is needed for treatment and how it must be obtained. Parents and guardians are encouraged to discuss vaccination with their child before attending a clinic.

  Even if an individual is able to provide informed consent, we encourage them to talk about their decision with their parent / guardian or health care provider.

  The health care provider and family must respect an individual's decision about vaccination.

  If the individual is incapable of consenting to receiving the vaccine, they would need consent from their substitute decision-maker, such as their parent or legal guardian

• Is there anything I can read in advance so I can be ready to provide consent at the clinic?

  We encourage you to check out the Ministry of Health page on what to expect when you get a COVID-19 vaccine.

The CARD system

• What is the CARD system?

  The CARD system (Comfort, Ask, Relax, Distract) provides a group of strategies that can be used before and during vaccination to make the experience a more positive one for you and your child.

• How can I help my child use CARD during vaccination?

  Learn how you can play your CARDs during your child's vaccination. Help your child choose what CARDs they want to play to reduce the pain, stress and worry about getting a needle.

  Although privacy or lying down may not be an option at Public Health clinics, the health care provider at the clinic will do their best to help put your child at ease. You can also talk to your health care provider about vaccinating your child.

• How do I help my child use CARD to cope with stressful situations?

  Help your child cope with anxiety or give them the CARD system for coping with their fears and anxiety.

Preparing your child for their vaccine

• How do I talk to my child about getting vaccinated?

  School-aged children can be told at home that they will be getting a needle. Answer the question:

  • "Why do I need a vaccine? with "To help you stay healthy."
  • "What will happen?"" with "The medicine will be put in your arm with a needle."
  • "How will it feel?"" with "You might feel a pressure or a pinch that will last a few seconds, or nothing at all" or "I don't know how it will feel for you. Let me know how it felt when we are done."
  • Use the credible sources of information from this page to help any other questions they may have.
• Where can I find social stories to prepare my child for their vaccination?

  Autism Canada has created story boards with pictures about the vaccine process for children who are non-verbal.

• What can I do if my child is anxious or nervous about getting a needle?

  Here are some ways you can help prepare your child for their COVID-19 vaccine:

  • Use the CARD system
  • Help answer questions they may have
  • Try to have your child eat something before they go to their appointment and make sure they wear a loose fitting top or t-shirt. Review this information about going to a COVID-19 vaccine appointment.
  • Review and practice helpful ways to stay calm, such as:
  • Sitting up right during the needle and relaxing your arm
  • Taking deep belly breaths before, during and after the needle. This is like blowing up a balloon or blowing out candles.
  • Have your child bring an object with them to get their mind off the needle, such as a mobile device, fidget spinner or book
• What if I fainted the last time I got a vaccine or I have a fear of needles?

  If you have fainted, or became dizzy with previous vaccinations or procedures, or if you have a high level of fear about injections, you should still get the vaccine. Tell the health care provider at the clinic so that appropriate supports can be offered. You can also bring a person with you for support such as a family member.

• What can I do if my child finds needles painful?

  If your child finds needles painful, you may wish to apply a topical anesthetic before going to the clinic to numb the area. No prescription is needed. Topical anesthetics are available at a pharmacy. Follow the directions on the package to know where and when it should be applied. For example, 30 minutes to one hour before the scheduled appointment.

• How do I hold my child as they are getting vaccinated?

  Different comfort positions are available that help your child feel secure and stay still during vaccination.

What to expect at the clinic

• What will the clinic feel like?

  We strive to make our clinics calm and positive for children and their families by:

  • Offering booked appointments to avoid waiting
  • Allowing more time for each child in order to talk through any questions and get comfortable
  • Additional space so parents and siblings can be together
  • Putting children and youth who may be anxious or nervous at ease by asking them what makes them comfortable and helps them relax
  • Using distractions to keep children busy while they are getting vaccinated, like small, colourful toys or tablets to watch videos
  • While they wait 15 minutes after getting vaccinated, children can get their picture taken in a "I stuck it to COVID" selfie frame, read a book or colour a picture that they'll be given
  • When they leave, children will be offered a piece of peanut-free candy
• What if someone feels faint at the clinic?

  Faints or near faints can be common among youth immediately after getting a vaccine. Reducing your anxiety can help prevent this.

  You will remain in our recovery area for a minimum of 15 minutes after your vaccine. If you feel faint, it's important not to stand up. Alert our clinic staff to help you.

• Will children and youth receive a record of their vaccination?

  Yes. Ontario COVID-19 vaccine certificates will be available for children and youth on the COVID-19 vaccination portal as a record of their vaccination.

School

• Are children five years of age and older required to get a COVID-19 vaccine to attend school?

  In Ontario, COVID-19 vaccines are voluntary. Anyone eligible is strongly encouraged to get vaccinated.

  There is no legislation related to the COVID-19 vaccination.

  Existing medical exemption and statement of conscience forms available on the Ministry of Health's website don't apply to COVID-19 vaccines at this time as they are specifically for Ontario's Immunization of School Pupils Act. Parents and guardians shouldn't fill out these exemption forms as it doesn't provide a valid exemption for COVID-19 vaccination for their child.

  Learn about required vaccinations for child care and school.

  We encourage the public to visit Ontario's vaccination website for updates to vaccination requirements.

COVID-19 Vaccination

• Getting Vaccinated
• Clinic Schedule
• Children and Youth
• Fertility, Pregnancy and Breastfeeding
• Frequently Asked Questions
• Vaccination Statistics
• COVID-19 Information
• Posters and Resources