Teens, kids 12-15 and the COVID-19 vaccine: What parents should know

With children ages 12 -15 years and teens ages 16 years and older now eligible to receive the COVID-19 vaccine, parents may have questions about the vaccine and what to expect afterward. Here, Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network, answers some common questions about the vaccine, teens and kids.

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Dr. Angela Dangvu, a CHOC pediatrician
What vaccine will my teen or child receive?

At this time, the Pfizer vaccine is the only vaccine authorized for use in teens ages 16 and older and children ages 12-15 to prevent COVID-19. It is administered in two doses three weeks apart, injected into the arm muscle.

The Pfizer vaccine, as well as the Moderna vaccine, which is authorized for people ages 18 years and older, is an mRNA vaccine. When the vaccine is injected, mRNA – a strip of genetic material – enters a body’s cell and prompts the cell to build copies of spike proteins. These spike proteins are the bumps that protrude from the surface of coronavirus particles. The body’s immune system then learns to spot these spike proteins and produces antibodies that block the virus from entering healthy cells in the future.

Studies show that vaccine recipients achieve immunity about two weeks after receiving the vaccine’s second dose. Scientists are still learning about how long that immunity will last.

I have younger children. What is the status of vaccine research in children younger than 12 years old?

To date, Pfizer and Moderna have enrolled children as young as 6 months in clinical trial studies. Janssen and Astra Zeneca also have plans to study their vaccines in younger age groups.

Is the vaccine safe for teens and kids? Are there other risks for teenagers and children that might not be present for adults?

The Pfizer vaccine is absolutely safe for children ages 12-15 years and teens ages 16 years and older. In clinical trials, enough teens and children participated to show that the vaccine is safe for 12-year-olds and older. We have no reason to expect that children would tolerate the vaccine less favorably than adults would.

If children and teens are less likely to get sick from COVID-19, why do they need a vaccine?

Even though it is rare for children to get seriously ill from COVID-19, children who are 12 years and older have needed hospital care for COVID-19. This is especially true for children and teenagers with underlying health conditions such as weakened immune systems, obesity or chronic lung conditions. Having the vaccine may also give parents, teens and kids alike peace of mind to return to more typical activities like in-person instruction and participating in sports, which is great for mental health.

Are there any teens or children who shouldn’t get the vaccine? Should I talk to my pediatrician before scheduling the appointment?

There is no category of children or teenagers who shouldn’t get the vaccine, unless they have a known allergy to one of the vaccine’s components. Because it isn’t a live vaccine – a vaccine that uses a weakened form of a germ to prompt an immune response – people with weakened immune systems, either from illness or medication, may still receive the vaccine. There have been reports allergic reactions to the vaccine, but these occurrences are very rare. Vaccine recipients are monitored for 15 minutes after receiving the injection in case of any allergic reaction, and anyone with a history of severe allergic reactions to foods or medications (who carry an epinephrine auto-injector) are monitored for 30 minutes. Children and teens with other types of allergies beyond any vaccine component can feel safe receiving the vaccine.

Children or teens who recently received other vaccinations should wait two weeks before seeking the COVID-19 vaccine.
Parents are always encouraged to speak with their teen’s or child’s pediatrician if they have any questions or concerns.

Will the COVID-19 vaccine affect my child’s fertility?

Definitely not. Because it is an mRNA vaccine (see explanation above), the vaccine does not get incorporated into or change the DNA of the body’s cells in any way. There is no reason to worry that the vaccine will affect fertility or future offspring.

The COVID-19 vaccine was developed quickly. Should I be concerned about that?

No. The vaccine was developed quickly because scientists received additional money and resources to support from the government. This allowed scientists to follow all the typical processes but overlap some steps, which sped up the process. Also, it was easy to find volunteers to participate in clinical trials because many were excited by the possibility of receiving the vaccine. None of these factors compromised the quality of the trials, and the same processes for safety and effectiveness was followed. 

I’ve read about COVID-19 variants. Will the vaccine protect my teen or child against them?

We are still learning about how effective the vaccine is against variants. While there may be some decrease in immune response, the vaccine is still largely protective. An important step in fighting variants is to ensure as many people as possible get the vaccine. The more people who get sick – even mildly – with COVID-19, the more opportunity is presented for the virus to continue to mutate.

My teenager or child already had COVID-19. Should they have the vaccine?

Yes. We don’t know how long the immunity lasts from natural illness, and the vaccine is made to create a longer lasting immune response.

What if my teenager or child has COVID-19 now?

Your child or teen should wait until they are feeling better and no longer need to isolate based on guidelines from the Centers for Disease Control.

What if my child has received convalescent plasma treatments?

Your child or teen should wait 90 days to get the vaccine after receiving convalescent plasma or monoclonal antibody treatments. Your child’s pediatrician can help you determine when it’s appropriate to get the vaccine.

Can my child take their normal medications before the COVID-19 vaccine?

Your child should continue to take their normal medications as prescribed.

Can my child take acetaminophen, ibuprofen or an antihistamine before the COVID-19 vaccine to offset any potential side effects?

No. It is best to avoid preventatively administering these medications – either before the vaccination or right afterward if no side effects are present – because there is a chance they can decrease the immune response.

Do I need to accompany my child to the vaccination?

Yes. Anyone under 18 must have a parent or legal guardian present to receive the vaccine.

What should we bring to my teen’s COVID-19 vaccination appointment?

Bring photo ID, such as one from school or the government, and a document verifying your child’s date of birth, such as a birth certificate or a medical visit summary with their name and date of birth. There’s no need to bring your child’s vaccine records, as they will receive a card specific to the COVID-19 vaccine. It would be helpful if the teen or child wears a short-sleeved shirt, as the injection is administered into the arm.

What should my child expect at the COVID-19 vaccination appointment?

After checking in and taking care of paper work, the teen or child will be asked some questions about their health. The shot will be administered into the arm. After receiving the shot, the teen or child will be monitored for 15 minutes to ensure no adverse reactions. They will also receive a card indicating when they received the vaccine and information about the vaccine.

What should I do with their vaccination card?

Take a picture of it just in case and store in a safe place. There is no need to laminate it.

Do we really need to come back for a second COVID-19 vaccine?

Yes. Clinical trials that led to the Pfizer vaccine’s licensing incorporated two doses. So, the determined efficacy is based on two doses and we don’t yet know how effective one dose alone is. The Johnson & Johnson/Janssen vaccination is administered in one dose, but at this time it is only approved for people ages 18 and older.

What are the side effects of the COVID-19 vaccine? Are there any different side effects for kids?

The most common side effects are fever and feeling achy or tired. Any side effects should be relatively short-lived and ease within 24 hours. Because teens and children have more robust immune systems, it’s possible that they may feel these side effects more strongly than adults would. This is a sign that their immune system is mounting a response against the virus.

If side effects do appear after the COVID-19 vaccination, what can I use to treat them?

It is fine to treat side effects once they surface with over-the-counter pain medicine. Either ibuprofen or acetaminophen is fine, so long as the child hasn’t had previous reactions to these medications.

Should my child stay home from school after the COVID-19 vaccine?

If they have a fever, the teen or child should stay home. Beyond that, so long as they are feeling well, there is no need to limit activities.

What if my child is exposed to COVID-19 after they’ve been vaccinated?

Once two weeks have passed since their second dose, they have reached full immunity and there is no need to self-isolate after exposure to someone with COVID-19. Monitor them closely, however, to ensure they aren’t developing symptoms. If COVID-19 symptoms surface, begin self-isolation and contact your pediatrician.

After receiving both COVID-19 vaccine doses, can my child stop wearing a mask?

No. It’s important that they continue to take precautions against COVID-19. Though they are highly effective, the vaccine is not 100 percent effective, and while among a group of people, it’s impossible to know who is and who isn’t vaccinated.

How will the COVID-19 vaccine change socializing for my child?

Teens, children and families alike can definitely have more peace of mind about the safety of resuming more typical activities, which will be wonderful for mental health. In group activities, kids ages 12-15 and teens 16 and older should still continue to wear masks. In one-on-one activities where a child or teen and their friend are fully vaccinated, they can feel comfortable removing their masks so long as no one in either household is high-risk and unvaccinated.

Should I be concerned about having my older vaccinated teen or child around their younger siblings who are not vaccinated?

No. These children were already interacting with each other in the same household before one received the vaccine. The entire family can take comfort in knowing that one more person in household who has been vaccinated offers more protection for the whole family.  

Get more information from CHOC experts about COVID-19 and kids.

Protecting against dry hands from frequent handwashing during COVID-19

Frequent and thorough handwashing remains a top method of protecting against COVID-19 and other viruses, but dry and cracked hands may be an unfortunate side effect in children and adults alike.

“Thorough handwashing is an absolute must during COVID-19, but it can lead to dry skin ,” says Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network. “There’s a lot we can do to help, while still ensuring proper handwashing is maintained.”

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Dr. Angela Dangvu, a CHOC pediatrician

Here, Dr. Dangvu offers tips to help protect tiny hands against dryness without compromising thorough hand washing that’s so critical during the pandemic.

Choose soap carefully

Start by choosing a moisturizing hand soap, Dr. Dangvu says. Pick soaps that look more like lotions than  a typical soap with words like “moisturizing” or “conditioning” on the packaging. Unless your child is already using these and is accustomed to them, try to skip antibacterial or deodorant soaps.

If they are available, use soap and water instead of hand sanitizer, Dr. Dangvu advises. The alcohol content in the hand sanitizer can sting hands that are already dry and cracked. If hand sanitizer is only available, be sure that it has at least 60 percent alcohol to ensure a thorough cleaning.

Timing is important

Parents should remind their children that when they are at home, they ought to be washing their hands at these times:

  • Before and after cooking or eating
  • After using the restroom
  • After cleaning around the house
  • After touching family pets
  • Before and after caring for a sick family member
  • After blowing their nose, coughing or sneezing
  • After changing a diaper
  • After being outside — playing, gardening, walking the dog, etc.

Beyond these instances, children do not need to continually wash their hands at home, Dr. Dangvu says.

“Children are such great learners and have been so incredibly adaptable during the pandemic, and many have really taken on to importance of handwashing,” she says. “Too frequent handwashing can worsen dry and cracked hands.”

Creams, not lotions

Applying moisturizer to a child’s hands after hand-washing or bath time can also help prevent dry hands. Select products described as creams rather than as lotions: The former are richer and have more staying power than thinner products like baby lotions, Dr. Dangvu says.

“They tend to stay on and be a better moisture barrier,” she says. “Parents should use them right after children wash their hands. If skin is still a little moist, the cream will trap that moisture. Apply it after bath time too.”

A three-step approach

If a child’s little hands still become dry, Dr. Dangvu recommends a three-step approach:

  1. Start by regularly applying cream to the hands.
  2. If dryness doesn’t improve after a few days, move on to a petroleum-based ointment. Parents can intensify the therapy by applying ointment to hands before bed, and asking children to wear cotton gloves or even socks over their hands to lock in moisture while they sleep.
  3. If the condition doesn’t change after a few more days, parents can try an over-the-counter hydrocortisone cream.

If these steps don’t yield improvement, it’s time to consult the child’s pediatrician to rule out a bacterial infection or other condition, Dr. Dangvu says.

Learn more about the CHOC Primary Care Network.

Summer safety tips from your pediatrician

Kids are still kids, even during a pandemic – they play, they get sick and sometimes they get hurt. We spoke to Dr. Angela Dangvu, a CHOC  pediatrician, about what parents can do to keep kids safe this summer.

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Dr. Angela Dangvu, a CHOC pediatrician

COVID-19 precautions

With no vaccine currently available, the best way to prevent illness is to avoid being exposed. In addition to practicing proper handwashing, people should watch for symptoms and avoid going out if they feel ill. When outside the home, people should physically distance from others whenever possible, and wear a face covering. The Centers for Disease Control and Prevention recommends the use of cloth face coverings in public for those over age 2. The governor of California has mandated that face coverings be worn by the general public when outside the home. Read the full order, including exemptions, here.

Be safe around water

A child can drown in as little as 2 inches of water – so keep an eye on all bodies of water like bathtubs and ice chests, in addition to pools. Assign a “water watcher” who knows how to swim and can provide constant, uninterrupted supervision. Learn more about water safety.

Wear your sunscreen

Everyone over 6 months should wear sunscreen when they’re outdoors. Infants younger than 6 months should be kept out of the sun.

Apply a sunscreen with SPF 30 at least 15-30 minutes before you go outside. Reapply every two hours or after swimming or sweating. Wide-brimmed hats and sunglasses offer extra protection. Limit time spent outside between 10 a.m. and 4 p.m. to minimize down on sun exposure. Also be aware that surfaces like sand and water reflect sunlight, so it’s possible to get burnt even when you’re in the shade. This is especially true for infants.

Review family emergency preparedness plans

Emergencies are not on pause just because there is a pandemic. Create and practice a fire escape plan with your family. Double-check smoke alarms and carbon monoxide detectors.

Practice poison precautions

Avoid household poisoning hazards and save the Poison Control Center’s phone number in your cell phone: 1-800-222-1222 for serious emergencies or simple questions. Store medicine and vitamins up high and out of sight. Remind children that medicine is not candy.

Helmet safety

Most serious head injuries can be avoided by wearing a properly fitting helmet. By law in California, everyone under 18 years of age must wear a Consumer Product Safety Commission-approved helmet while bicycling, riding a scooter, skateboard, or using roller-skates or in-line skates. Parents should enforce this rule even when kids are riding in areas where they don’t expect to encounter vehicles.

Learn more about the most common summer injuries that send kids to the emergency department – and how to avoid them.

If your child is ill or injured during the COVID-19 pandemic, rest assured that it is safe to seek the care they need. Here’s a guide on deciding where to go for care during COVID-19.

This article was updated July 22, 2020.

Body mass index or BMI: What parents should know

By Dr. Angela Dangvu, a CHOC Children’s pediatrician

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Dr. Angela Dangvu, a CHOC Children’s pediatrician

 As a pediatrician, I spend much of my day doing well child visits for my patients. A big part of those appointments is looking at a child’s growth. Parents are usually interested in knowing their child’s weight and height percentiles, but they rarely ask directly about body mass index or BMI.

What is body mass index?

BMI is a measure of a person’s weight in relation to their height. It varies based on the age and gender of the person and is used to estimate the amount of body fat.

BMI is calculated starting at 2 years of age.  At this age it tends to be higher and will generally get lower until a child is 5 or 6 years old. Then, it will increase with age as they grow into early adulthood. Often, parents of children ages 3 to 4 ask me if their child is too skinny. They’ve begun to notice that their once chubby-looking toddler has thinned out. This is completely normal but can cause parents to overfeed their child because they think they are underweight.

Kids come in many different shapes, so they shouldn’t all have the same BMI. There is a wide range of BMIs that are considered normal. On the lower end, the normal range for BMI starts at the 5th percentile — meaning that 5% of children of the same age and gender will have a BMI lower than them. On the higher end of normal is a BMI in the 85th percentile, which means that 85% of kids of the same age and gender will have a lower BMI.

A BMI lower than the 5th percentile is considered underweight, while a BMI between the 85th and 95th percentile is in the overweight category. A BMI of more than the 95th percentile is considered obese.

When a child’s BMI indicates that they are underweight, it can be a sign of a medical condition that is preventing them from gaining weight. When a child’s BMI puts them in the overweight or obese range, we as pediatricians worry that they could be gaining too much weight, putting them at risk for diseases like diabetes or high blood pressure when they are older.

What body mass index is not

BMI is not a perfect measurement of a child’s body fat, but rather it is just one tool that we use in evaluating a patient’s overall growth and nutrition.

For example, a child being underweight doesn’t always mean they have a medical condition or are not getting enough calories. The child could be underweight because of genetic factors; perhaps both parents were thin as kids, and their child is taking after them.

How your pediatrician can help you improve your child’s BMI

As physicians we look at multiple sources of information to determine why a patient is underweight. We look at the growth chart, medical history and family history. We might order lab tests and refer our patients to a specialist depending on the findings. If the child appears to simply need to consume more calories, I usually encourage the family to incorporate some more calorie-dense foods into the child’s diet, rather than getting into a power struggle with their child about the amount of food they are eating.

If your child’s BMI is in the overweight or obese category, your physician should work with your family to determine possible causes, and solutions as well. Many parents already know that their child’s weight is a concern, but others may not notice that it has become an issue.  With my patients, I try to identify factors in their diet and activity levels to find potential areas for change. One thing to remember with children is that they will continue to grow into their teens, meaning that the goal doesn’t usually need to be weight loss. If they can slow their weight gain or even go for a period of time without gaining weight as they grow in height, their BMI will improve.

Learn more about CHOC’s Primary Care Network

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