Pediatric COVID-19 Vaccination

If you are new to using COVID-19 vaccine, there are several critical differences in the storage and handling, administration, and clinical considerations for COVID-19 vaccine compared to routine immunizations.

• The COVID-19 vaccines for children under 12 are different formulations identified by specific-colored caps.
  • The Pfizer COVID-19 vaccine for 6 months through 4 years is identified by a yellow cap. The Pfizer COVID-19 vaccine for 5 through 11-year-olds is identified by a blue cap. Make sure you have the correct vaccine and know how to use it.
  • The Moderna COVID-19 vaccine for children 6 months through 11 years is identified by a blue cap/green label.
• Children age 6 months through 4 years may need multiple doses of COVID-19 vaccine to be up to date, depending on the number of doses they've previously received and their age.
• Children age 5 years through 11 years should get one Pfizer or Moderna 2024-2025 COVID-19 vaccine to be up to date.
• Children 12 years and older could choose to receive one dose of the 2024–2025 Novavax vaccine unless they are receiving a COVID-19 vaccine for the very first time. If they have never received any COVID-19 vaccine and they choose to get Novavax, they will need two doses of 2024–2025 Novavax COVID-19 vaccine to be up to date.
• Children ages 6 months and older who are moderately or severely immunocompromised are recommended to received multiple doses under shared clinical decision making. Talk to your child’s provider.
• For more details refer to CDC: Staying Up to Date with COVID-19 Vaccines.

Key things to know and share with patients

All parents/guardians and patients must receive an emergency use authorization (EUA) fact sheet or vaccine information statement (VIS) before vaccination and have their questions answered.

• FDA: Pfizer-BioNTech COVID-19 Vaccine
  Fact sheets for recipients and caregivers are available in many languages.
• FDA: Moderna COVID-19 Vaccine
  Fact sheets for recipients and caregivers are available in many languages.
• FDA: Novavax COVID-19 Vaccine, Adjuvanted
  Fact sheets for recipients and caregivers are available in many languages.
• CDC: COVID-19 VIS (PDF)

Parent or guardian consent is needed for vaccination, except under certain circumstances. Refer to Minnesota Statutes, sections 144.341 (minor living apart); 144.342 (minor who has given birth or been married) and 144.345 (recognizing good faith reliance upon representations of the minor).

• Explain what side effects to expect and how to manage them.
• Vaccination providers should consider observing vaccine recipients for at least 15 minutes after vaccination, especially adolescents.
• If indicated, make an appointment before they leave to get the next dose per the CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines vaccination schedule.
• Do your part to reach adolescents and children in Minnesota hit hardest by COVID-19.

Benefits of pediatric vaccination talking points

Use these talking points to help convey the importance of COVID-19 vaccination for adolescents and children.

Vaccine administration tips

• Answer any questions the child or parent/guardian has about vaccination.
• Use comfort measures to decrease pain and anxiety. Suggest the child:
  • Listen to their favorite music with headphones.
  • Breathe! Take slow, deep breaths.
  • Make eye contact with a supportive person.
  • Close their eyes and think of a favorite place or activity.
  • Focus on something in the room, like a poster.

How to hold your child during a vaccination (PDF)
Fact sheet with images and instructions for different comfort holds. Created in partnership with Homeland Health Specialists. Updated 6/17/22.

Fainting (syncope) can be common among children immediately after getting shots. For this reason, experts recommend having patients sit in a chair or lay down when they receive a vaccination. In addition, patients may be observed for 15 minutes after vaccination. For more information, visit CDC: Fainting and Vaccines.

All vaccine administration has the risk of anaphylaxis. All adverse reactions and vaccine administration errors should be reported to the Vaccine Adverse Event Reporting System (VAERS).

Find ways to decrease barriers for families

• Aim to offer multiple ways to schedule and/or allow walk-ins for COVID-19 vaccination.
• Extend hours: Try to offer early morning, evening, or weekend appointments for caregivers to bring in children for COVID-19 vaccination.
• Consider working with schools, local health departments, other local community organizations, or mobile vaccination units to help facilitate community vaccination drives specifically for children and families from areas with high social vulnerability factors.
• Find a list of MDH's COVID-19 Community Coordinators and Engagement Contractors at COVID-19 Contracts for Diverse Media Messaging and Community Outreach.
• The Minnesota Immunization Information Connection (MIIC) can be used to identify patients in specific ZIP codes who have yet to receive COVID-19 vaccine and/or their routine immunizations. Using the client follow-up functionality in MIIC, providers can pull a list of clients and their contact information (including ZIP code). The user guidance for this function can be found at Client Follow-Up.

Reach out to highly impacted communities

Consider reaching out to children and families in communities that have experienced a high burden of COVID-19 disease and impact, including:

• Black, Indigenous, Hispanic, and Asian Pacific Islander communities.
• Children with disabilities.
• Children with other medical comorbidities per CDC guidance: People with Certain Medical Conditions and COVID-19 Risk Factors.
• Children from households where the language spoken is not English (e.g., Somali, Spanish, etc.).
• Children on Medicaid/Minnesota Health Care Programs.

Resources

• CDC: Vaccines for Your Children
• CDC: Make Shots Less Stressful for Your Child
• IAC: How to Administer Intramuscular and Subcutaneous Vaccine Injections (PDF)
• IAC: Skills Checklist for Vaccine Administration (PDF)
• CDC Immunization Education and Training: You Call the Shots