COVID-19 Vaccination in Children and Youth

The town hall for parents and guardians of kids five to 11 is now available to watch online.

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
• 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 272 cases of MIS-C in individuals zero to 19 years of age have been reported in Canada as of Oct. 16, 2021. Forty per cent of cases occurred in children five to 11 years of age.

  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-haul COVID-19 after being infected?

  Yes, there is a possibility that children may be at risk of getting long COVID or post acute COVID-19 syndrome. 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.

• Can children die from COVID-19 infection?

  In Canada, 16 people aged zero to 19 have died from COVID-19 infection as of Dec. 3, 2021.

  Additionally, in the United States, COVID-19 is now the eighth leading cause of death in children age five to 11 years.

  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.

General information

• What vaccine is available 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.

• Will I have to book my second dose appointment for my five to 11 year old child?

  Individuals who use the COVID-19 vaccination portal can book their child's second dose appointment after they have received their first dose, at an interval of eight weeks. Individuals whose child receives their vaccine at a pharmacy should discuss with the pharmacy location about how they are booking second doses. Primary care providers will work with parents and caregivers whose children they vaccinate with a paediatric COVID-19 vaccine to book a second dose appointment. Clinics are added to the booking portal two weeks in advance.

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

  Children five to 11 years of age should receive the COVID-19 vaccine at least 14 days before or after another vaccine. This is a precaution to help to determine if a side effect that may arise is due to the COVID-19 vaccine or another vaccine. However, there may be circumstances when a dose of a COVID-19 vaccine and another vaccine need to be given at the same time. This would be determined by your health care provider.

  For those 12 years of age and older, the 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?

  Clinical trials are underway for infants and children under five years of age.

• 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.

  While being fully vaccinated will make it far less likely that you will get COVID-19 and pass it on to your children, breakthrough infections can happen.

  For now, it's very important that we continue to follow public health measures to keep each other safe.

Vaccine safety

• Where can I find the clinical trial data of the vaccine for five to 11 year olds?

  See the clinical trial data of the Pfizer-BioNTech (BNT162b2) vaccine for five to 11 year olds.

  Of note, normal side effects from the vaccine (such as fever, headache, muscle pain) were less common in children five to 11 years of age compared to older youth. Watch Dr. Hirji (Acting Medical Officer of Health for Niagara Region) explain the data.

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

  The development of COVID-19 vaccines was supported by decades of advances in vaccine technology. Learn about the decades of research that went into the development of mRNA vaccines.

  Learn more about 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?

  Here is what we know so far specifically for five to 11 year olds:

  • In the clinical trials for five to 11 year olds, no cases of myocarditis or pericarditis were linked to the vaccine. While the clinical trials may not pick up rare or very rare adverse events, no safety signals have been identified in the United States, where the vaccine has already been given to over three million children five to 11 years of age.
  • New evidence shows that an eight week interval between first and second dose may be linked with a lower risk of myocarditis and / or pericarditis in adolescents 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.

  In older youth and adults (those 12 years of age and older) where the vaccine has been given for many months now, reports of myocarditis and pericarditis after COVID-19 vaccination have been rare. These conditions are more common after COVID-19 illness than after vaccination.

  In the rare instances where it has occurred after vaccination, it seems to be:

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

  The symptoms of these conditions include chest pain, shortness of breath, or the feeling of a fast, pounding or fluttering heartbeat. Those who experience any of these symptoms after vaccination should seek immediate medical attention.

  As a precaution, the National Advisory Committee on Immunization recommends that anyone who experienced myocarditis or pericarditis after a first dose of an mRNA vaccine should wait to get their second dose until more information is available.

• 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.

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 documents on the Before and After your COVID-19 Vaccine page.

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 proof that they are vaccinated?

  Yes. Vaccine certificates with QR codes will be available for children and youth on the COVID-19 vaccination portal as a record of their vaccination.

  At this time, there are no requirements for children aged five to 11 to show proof of vaccination in Ontario. There may be different requirements in other jurisdictions. Learn more about proof of vaccination for youth 12 years of age and older.

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.

• How will administration of COVID-19 vaccine fit into school vaccinations (Grade 7, Immunization of School Pupils Act)?

  This webpage will be updated when there's more information.

  Learn more about school vaccination information.

COVID-19 Vaccination

• Getting Vaccinated
• Before and After your Vaccine
• Clinic Schedule
• Proof of Vaccination
• Children and Youth
• Fertility, Pregnancy and Breastfeeding
• Frequently Asked Questions
• Vaccination Statistics
• COVID-19 Information
• Posters and Resources
• Workplace Policy Resources