Preparing to Vaccinate Young Children: COVID-19

These tips are provided as a framework, particularly for sites that do not routinely provide vaccination services for children. This information cannot substitute for in-person, hands-on training from staff with experience vaccinating children. Each site is responsible for ensuring proper training and competency of their staff if they choose to provide vaccination services to children.

In addition to this checklist, all COVID-19 vaccine providers should complete the Required Training for Registered COVID-19 Vaccine Providers and be familiar with MDH's Interim COVID-19 Vaccine Provider Guide available at COVID-19 Vaccine Providers.

The developmental stage of a child will determine the social, psychological, and physiological approaches a vaccinator must use to safely vaccinate. Because vaccinating small children is very different than vaccinating adults, some staff may not be comfortable or willing to vaccinate young children. Please respect and consider that when determining if your vaccination site can provide services to young children and making subsequent staff assignments.

Training Transcript: COVID-19 Vaccines in Young Children (PDF)

Family-centered approach

• Parents should be with their child.
  • Occasionally a parent will not want to be present, so have someone to help as needed.
• Parents know their child best. Listen to them.
  • Ask parents what works best for their child when they come for their appointment.
  • Decreasing a parent's anxiety will help to decrease their child's anxiety.
• Provide parents with all the same patient education (including the emergency use authorization (EUA) fact sheet) and tell them what to expect after vaccination.
• Instruct the parent how to hold their young child and encourage them to help with distractors.
• Talk directly to children and answer their questions.
• Be honest. Explain that shots can pinch or sting, but that it won't hurt for long.
• Remind children that vaccines can keep them healthy.
• Give children some control.
  • Ask them questions like, "Which arm would you like your shot in?"
  • Don't ask them about things they can't control (i.e., "Do you want a shot?").
  • Let the child know they can be loud, but they cannot move.
• Distracting children can decrease pain and anxiety.
  • Sing or talk softly.
  • Point out interesting things in the room.
  • Tell or read stories.
  • Show them how to take deep breaths and help "blow out" the pain.
  • Wiggle all ten toes.
  • Squeeze a parent’s hand as hard as they can.
• Be supportive. Never scold a child for their reaction or not "being brave."

Additional resources:

• CDC: Before, During, and After Shots
• CDC: 9 Things to Make Shots Less Stressful for You and Your Baby

Environmental considerations

• Promote a family-friendly environment. Families may come with multiple children.
• Consider how the room/vaccination location set-up can reduce the “fear factor” of other children watching what is happening before their turn.
  • Privacy screens and cots should be available.
  • Don’t draw up the vaccine in front of the child. Have a clean area to mix and draw up the vaccine out of the child's view.
• Young children may cry, scream, or try to run away. A private place for vaccination such as an exam room may be necessary.
• Privacy may also be needed for a child needing an intramuscular (IM) injection in their thigh instead of arm.
• Provide books, pictures, bubbles, and other items that can be used to distract children.
• Consider having juice and crackers available for lightheaded children.

Vaccine administration in children

• For children under the age of 3 years intramuscular injection (IM) in the vastus lateralis muscle of the anterolateral thigh is preferred.
• For children 3 years and older intramuscular (IM) injection in the deltoid muscle is preferred, but the vastus lateralis muscle of the anterolateral thigh may be used.
• A one-inch needle is recommended for most children, unless they are very small or have little muscle mass.
  • Have an adequate supply of one-inch needles.
  • If using a 5/8-inch needle, hold the skin stretched flat with thumb and forefinger before injecting.
• Putting an ice pack on the arm before the injection can decrease the pain response for some children.
• Research shows children are less fearful when sitting up rather than lying down.
• Young children should sit in parent's lap with the parent embracing their child. Instruct the parent to use one of the recommended comfort holds.
  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
  
  Other languages: How to hold your child during a vaccination

  • How to hold your child during a vaccination in Amharic (PDF)
  • How to hold your child during a vaccination in Arabic (PDF)
  • How to hold your child during a vaccination in Chinese (PDF)
  • How to hold your child during a vaccination in French (PDF)
  • How to hold your child during a vaccination in Hmong (PDF)
  • How to hold your child during a vaccination in Karen (PDF)
  • How to hold your child during a vaccination in Lao (PDF)
  • How to hold your child during a vaccination in Oromo (PDF)
  • How to hold your child during a vaccination in Russian (PDF)
  • How to hold your child during a vaccination in Somali (PDF)
  • How to hold your child during a vaccination in Spanish (PDF)
  • How to hold your child during a vaccination in Vietnamese (PDF)
  Video demonstrations of different holds

  Front hold

  Demonstration: Front Hold Transcript (PDF)

  Comfort hold

  Demonstration: Comfort Hold Transcript (PDF)

  Straddle hold

  Demonstration: Straddle Hold Transcript (PDF)

  Side sit hold

  Demonstration: Side Sit Hold Transcript (PDF)

• Administer the vaccine using rapid injection, no aspiration, and rapid withdrawal to minimize the pain response.
• Colorful and fun bandages and stickers are also helpful for children.

Additional resources:

• IAC: How to Administer Intramuscular and Subcutaneous Vaccine Injections (PDF)
• IAC: Skills Checklist for Vaccine Administration (PDF)
• CDC: You Call the Shots: Vaccines Web-based Training Course
• CDC: How to Hold Your Child during Vaccinations
• CDC: Comfort and Restraint Techniques (YouTube)
  Holding infants starts at 1:39, older children start at 3:30 in the video

Identify and respond to adverse events

• All vaccine administration has the risk of anaphylaxis.
• Every setting should have proper equipment, medications, and procedures in place to handle an anaphylactic reaction to a vaccine.
• All children should be observed for at least 15 minutes after vaccination.
• All adverse reactions and vaccine administration errors should be reported to the Vaccine Adverse Event Reporting System (VAERS).

Additional resources:

• IAC: Medical Management of Vaccine Reactions in Children and Teens in a Community Setting (PDF)
  • Table with signs and symptoms and management of different reactions.
  • Protocol and suggested medications and supplies.
  • Dosage chart for young children.
  • Can be signed by medical director and used as protocol.