Kids & COVID

Updated June 24, 2022

Go to maps of locations offering vaccinations for children 6 mo-4 yrs and 5-11 years old.

The FDA and CDC have authorized COVID-19 vaccines as follows:

PFIZER VACCINE
Age 6 mo -4 years   3 dose series
Age 5+       2 dose series plus booster
Age 5+       Immunocompromised can receive 2nd booster
Age 50+       2 dose series plus booster plus 2nd booster

MODERNA VACCINE
Age 6 mo – 17 years   2 dose series
Age 18+       2 dose series plus booster
Age 50+       2 dose series plus booster plus 2nd booster

J&J VACCINE
On May 5, 2022, the FDA limited who can receive Johnson & Johnson’s COVID-19 vaccine due to the ongoing risk of rare but serious blood clots. The shot should only be given to adults who cannot receive a different vaccine or specifically request the J&J.

Those who are severely immunocompromised or have other concerns related to age or medical condition have slightly different vaccination recommendations. Check with your healthcare provider.

To learn more and find vaccination sites go to Vaccines.gov

Research continues on how COVID-19 affects children and on the efficacy of COVID-19 vaccines in those under 18. These answers to Frequently Asked Questions have drawn on multiple sources to provide answers to questions that you may have about Children and COVID-19.

Vaccinations for Children Age 6 Months - 4

Following FDA review and Emergency Use Authorization, the CDC has released supplies of the new Moderna and Pfizer vaccines for children under 5. The NH DHHS is distributing the vaccines to authorized pediatricians' offices for the following reasons:

Pediatricians have the best patient history for these children and have trusted relationships with their families.
Pediatricians have extensive experience with vaccinating small children.
The administration of the COVID-19 vaccine provides the opportunity to administer other childhood vaccines.
The pediatricians' offices are an appropriate medical environment for vaccination -- and immediately addressing any issues that arise.
NHDHHS will be apportioning its first supplies of the under 5 vaccines -- and the detailed instructions differentiating all the vaccines -- to the pediatricians who have signed up for their distribution network.

NHDHHS said on their Jun 9 Health Care Provider call that if the FDA/CDC recommended the new vaccines for EUA as expected on 17 Jun, the state would start delivering vaccines on Jun 20 to the pediatricians who had ordered by 8 Jun, and would deliver Jun 23-29 to the pediatricians who ordered after Jun 8.

SOME of the commercial pharmacies that have been participating in the Federal vaccine distribution network will receive the under 5 vaccines. But not all (CVS, Walmart, RiteAid) will have the same rules. WalMart, for example, will only vaccinate children in the 3-5 yr range. Check Vaccines.gov for more details.

Vaccinations for Children Age 5-11

On November 2, 2021, the CDC followed up on FDA Emergency Use Authorization for the special, low-dose Pfizer vaccine with a recommendation to vaccinate children age 5-11. This vaccine is expected to be available from pediatricians officers and healthcare providers starting November 8.

Boosters for Children Age 5-11

Following FDA Emergency Use Authorization on May 17, the CDC on May 19 recommended a booster dose of the Pfizer-BioNTech vaccine for children ages 5 to 11. Children in this age group who received their last dose at least five months earlier are eligible to receive the additional doses immediately.

Vaccinations for Children Age 12-17

Children aged 12 – 17 are eligible to receive the Pfizer vaccine following approval by the FDA as an extension of the Emergency Use Authorization [EUA] and action of the CDC.

Boosters for children Age 12-17

The CDC recommends Pfizer boosters for 12-17 year-olds (Click here for more details)

CDC UPDATE ON OPTIONAL SECOND BOOSTER -- On March 30, 2022 The CDC updated their Interim Clinical Considerations for Use of the COVD-19 Vaccines to allow for a 2nd booster dose in certain persons:

Persons 12 years of age or older who are moderately or severely immunocompromised may choose to receive a 2nd mRNA booster at least 4 months after their 1st booster
All persons 50 years of age or older (regardless of immunocompromised status) may choose to receive a 2nd mRNA booster at least 4 months after their 1st booster
Persons 18-49 years of age (regardless of immunocompromised status) who received the Janssen COVID-19 vaccine for both their primary series and 1st booster may receive a 2nd mRNA booster at least 4 months after their Janssen booster

ANYONE over 12 (only the Pfizer vaccine is approved for those age 12-17); Moderna and J&J are approved for those age 18 and over), regardless of residence is eligible to sign up to receive the vaccine. Walk-in vaccinations are now available at many local pharmacies and healthcare providers' offices. For an up-to-the-minute interactive directory of locations offering free vaccinations nearby, click here.

You can also text your zip code to 438829 to receive a listing of all the sites in your area that have the vaccine. The text that comes back also asks if the individual needs a ride and if so, the ride is set up for them. If needed, free childcare is made available while getting vaccinated (just send a reply text with “CARE” ). There is also a phone number listed: 1-800-232-0233 to get more help and/or info.

What are the best face masks for children? Are there N95 masks for kids?

St. Jude Children's Research Hospital recommends children wear the white, duck-bill N95 masks because cloth masks "do not provide the same level of protection and should not be used."

The white duck-bill N-95 mask comes in two sizes, small and regular, and is shaped outwardly like a duck's mouth. The design was created to offer more breathability.

How common is COVID-19 in children? What children are at greater risk?

According to the CDC, while fewer children have been sick with COVID-19 compared to adults, children can be infected with the virus that causes COVID-19, can get sick from COVID-19, and can spread the virus that causes COVID-19 to others.

Some children can become severely ill with COVID-19. They might require hospitalization, intensive care, or a ventilator to help them breathe. In rare cases, they might die.

Babies under 1 year old might be more likely to have severe illness from COVID-19. Other children, regardless of age, might also be at increased risk of severe illness compared to other children if they have any of the following medical conditions:

Asthma or chronic lung disease
Diabetes
Genetic, neurologic, or metabolic conditions
Sickle cell disease
Heart disease since birth
Immunosuppression (weakened immune system due to certain medical conditions or being on medications that weaken the immune system)
Medical complexity (children with multiple chronic conditions that affect many parts of the body, or are dependent on technology and other significant supports for daily life)
Obesity

This list does not include all the possible underlying conditions that could increase your child’s risk. If your child has any underlying condition, make sure to discuss your child’s potential for getting very sick with their healthcare provider.

Children, like adults, who have COVID-19 but have no symptoms (“asymptomatic”) can still spread the virus to others.

What COVID-19 symptoms are seen more often children as compared to adults?

Most children with COVID-19 have mild symptoms or have no symptoms at all.

Symptoms of COVID-19 are similar in adults and children and can look like symptoms of other common illnesses such as colds, strep throat, or allergies. The most common symptoms of COVID-19 in children are fever and cough, but children may have any of these signs or symptoms of COVID-19:

Neck pain (this study has found this to be a symptom)
Fever or chills
Cough
Nasal congestion or runny nose
New loss of taste or smell
Sore throat
Shortness of breath or difficulty breathing
Diarrhea
Nausea or vomiting
Stomachache
Tiredness
Headache
Muscle or body aches
Poor appetite or poor feeding, especially in babies under 1 year old

What should I do if my child is exposed to COVID-19 or if he/she has any of the above symptoms?

If you think your child has been exposed to COVID-19 symptoms it is important to monitor for and pay particular attention to:

Fever (temperature 100.4 °F or higher)
Sore throat
New uncontrolled cough that causes difficulty breathing (for a child with chronic allergic/asthmatic cough, see if there is a change from their usual cough)
Diarrhea, vomiting, or stomachache
New onset of severe headache, especially with a fever

Keep track of with whom your child comes into close contact and if your child or you were around someone who has COVID-19, follow NH DHHS guidelines for quarantine following suspected or known exposure.

If your child has symptoms of COVID-19:

Keep your child at home
Consider whether your child needs to see a healthcare provider and be tested for COVID-19. The CDC recommends all people with symptoms, including children, get tested. For information on local testing sites see these FAQs on Testing.
Protect yourself while caring for your child by wearing a mask, washing your hands frequently, monitoring yourself for symptoms for COVID-19, and using other preventive measures.
Notify your child’s school that your child is sick. Also inform the school if your child has had a COVID-19 test and what the result is, if available.
Review your child’s school (or other childcare facility) policies related to when a child who has been sick can return.
Bring your child back to school or other in-person activities only after they can safely be around others.

In a medical emergency, call 911 or bring your child to the hospital emergency department. Do not delay seeking emergency care for your child because you are worried about the spread of COVID-19. Emergency departments have infection prevention plans to protect you and your child from getting sick with COVID-19 if your child needs emergency care.

If your child is showing any of these emergency warning signs, seek emergency medical care immediately:

Trouble breathing
Pain or pressure in the chest that doesn’t go away
New confusion
Can’t wake up or stay awake when not tired
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

This list does not include all possible symptoms; Call your child’s healthcare provider for any other symptoms that are severe or concerning to you.

What is MIS-C?

Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.

What should I do if I think my child is sick with MIS-C?

Contact your child’s doctor, nurse, or clinic right away if your child is showing symptoms of MIS-C:

Fever
Abdominal pain
Vomiting
Diarrhea
Neck pain
Rash
Bloodshot eyes
Feeling extra tired

Be aware that not all children will have all the same symptoms.

Seek emergency care right away if your child is showing any of these emergency warning signs of MIS-C or other concerning signs:

Trouble breathing
Pain or pressure in the chest that does not go away
New confusion
Inability to wake or stay awake
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
Severe abdominal pain

How is MIS-C treated?

Once in the hospital, the medical team may do certain tests to look for inflammation or other signs of disease. These tests might include:

Blood tests
Chest x-ray
Heart ultrasound (echocardiogram)
Abdominal ultrasound

Treatment may include supportive care for symptoms (medicine and/or fluids to make your child feel better) and various medicines to treat inflammation. It is possible your child will need to be treated in the pediatric intensive care unit (ICU).

Parents or caregivers who have concerns about their child’s health, including concerns about COVID-19 or MIS-C, should call a pediatrician or other healthcare provider immediately.

What are the current recommendations for children in school regarding COVID-19?

This chart detailing what to do if a schoolchild has COVID-19 or is exposed comes from the NH DHHS School Toolkit (October 25,2021) with extensive guidance for schools and parents:

What to do if student has COVID or is exposed

In April 2021 the CDC provided these guidelines for children returning to school.

A summary of the guidelines allows for children to return to school with 3’ of physical distancing among students (6’ between students and adults and among adults in groups) while being monitored and controlled in the classroom. While physical distancing guidelines in the classroom have been revised, all other guidelines remain in place to prevent the spread of COVID-19 including:

Universal and correct use of masks
Physical distancing of 6’ when not sitting at one’s desk
Frequent handwashing
Respiratory etiquette [related to coughing, sneezing, tissue disposal]
Cleaning and maintaining healthy facilities
Contact tracing in combination with isolation and quarantine

How are the recommendations for physical distancing different based on grade level?

The CDC recommendation based on grade level is aimed at students in classrooms:

- In elementary schools, students should be at least 3 feet apart
- In middle schools and high schools, students should be at least 3 feet apart in areas of low, moderate, or substantial community transmission
- In areas of high community transmission (100 or more cases per 100,000 people), middle and high school students should be 6 feet apart if keeping the two age groups, or “cohorts,” apart is not possible
- When cohorting can be used limit contact between cohorts, the groups should maintain 6’ of physical distance

Even within the classroom the guidelines call for 6 feet of distance in the following settings:

- Between adults (teachers and staff), and between adults and students, at all times in the school building
- When masks cannot be worn, such as when eating.
- During activities when increased exhalation occurs, such as singing, shouting, band, or sports and exercise. Move these activities outdoors or to large, well-ventilated space, when possible.
- In common areas such as school lobbies and auditoriums.

What about participation in sports and other after-school or community activities?

Where and when community transmissions remains “substantial,” think carefully about decisions you make about whether to participate in these activities.

Travel restrictions apply following international travel or travel on cruise ships. Families should make travel decisions based on the needs of the family and an understanding of the quarantine requirements. This is especially important as children attending in-person school would be required to learn remotely during the quarantine period.

Outdoor sports carry a lower risk of spreading COVID-19 compared to sports that are played indoors or that have an indoor component. Two of the benefits of outdoor sports are open ventilation and the neutralizing effect of sunshine on the virus. Outdoor sports and play, combined with facial coverings and physical distancing as specified in the NH Universal Best Practices, provide an opportunity to keep kids active in a lower risk setting

Sharing of sports or other activity related equipment is discouraged. If this occurs the equipment should be disinfected between users. Even if the equipment has not been used by others disinfecting at the end of the activity is highly recommended.

Be sure your child understands the need to use only his/her own equipment and knows who to ask for help with disinfection should another person use the equipment.

What about play dates and getting together with friends outside of school?

As your child returns to school and other activities a good “rule of thumb” is to keep the child’s play and social activities limited to other children in their “pod” at school. This will limit the number of different people that come in contact with your child and may decrease his/her chances of contracting the infection.

What about travel with my kids?

The CDC has stated that “Fully vaccinated people can resume domestic travel and do not need to get tested before or after travel or self-quarantine after travel.”

Those who have received their COVID-19 vaccines also no longer need to get tested before leaving the United States, unless required by the destination, and they don’t need to quarantine after arriving back in the United States. However, vaccinated travelers still need to get tested prior to arriving in the United States. Those flying into the country from abroad who are age two and older, including returning U.S. citizens and permanent residents, must still provide proof of a negative COVID-19 test or documentation of recovery from COVID-19 prior to boarding their flight—vaccinated or not—per Federal order that went into effect on January 26, 2021.

Recommendations and requirements around international travel continue to evolve based on the country visited and the vaccination or post-COVID-19 status of the traveler. Click here for the current CDC guidelines on international travel.

How can I protect my kids from getting COVID-19?

If your child is between the ages of 12 and 17, vaccinations will go a long way toward protecting them, and those they with whom they come in contact, from contracting COVID-19. For the Vaccination FAQs, click here. If you have questions or concerns discuss them with your child’s primary care provider for information and answers that are specific for your child.

For those children not yet eligible for vaccination or who cannot be vaccinated the best way to prevent them from becoming sick with COVID-19 is to avoid exposing them to people who are (or who might be) sick with the virus, including family members. Here are three of the best ways to protect kids from infection:

Maintain physical distancing. The more people your kids come in contact with, and the longer the duration of that contact, the higher the risk of infection with the coronavirus.

Children should stay at least 6 feet from others outside of their household. Current NH guidelines allow for 3 feet physical distancing while in school under controlled and monitored conditions.
Check your kids’ day care and schools to ensure physical distancing measures are in place.
Limit in-person play with children not in your child’s school group, and be sure the children wear masks properly.
Ensure that children limit close contact with children and adults who are vulnerable, such as those with health conditions.

Wear a mask. When in public, adults and kids should wear a mask that covers both nose and mouth, especially in situations outside the home where physical distance isn’t possible.
Hand hygiene. Kids should wash their hands after using the bathroom, sneezing, coughing or blowing their nose, before eating (even snacks) and immediately after coming inside from playing outdoors.

Teach kids to wash their hands regularly, with soap and warm water, for at least 20 seconds. “They can help keep track of time by singing the ABCs, which takes about 20 seconds to finish.”
If soap and water are not available, the best option is hand sanitizer containing at least 60% alcohol.

Are masks safe for children?

This article by Dr. Brian O'Sullivan, pediatric pulmonologist at Children's Hospital at Dartmouth-Hitchcock addresses concerns.

Are there vaccines approved for children?

The Pfizer vaccine is currently available for teens aged 12+ years old in NH. CDC and DHHS recommend vaccination for this age group to help decrease the spread of COVID-19 and protect older teens from short- or long-term complications of COVID-19. Vaccinating kids in this age group will permit them to resume a more “normal” social life and return to school/work without the worry of contracting COVID-19 and/or infecting family and friends.

Several vaccine makers have begun early studies on the safety and efficacy of currently available vaccines for adults in the pediatric population. Children from age 6 months to 16 years are currently enrolled in these studies to determine vaccine dose, vaccine efficacy, and any side or adverse effects. As with the adult trials, the drug companies conducting these studies will provide data to the FDA when the studies are complete seeking approval for pediatric use IF the trials demonstrate the vaccine to be safe and effective.

It is recommended that everyone aged 12 or older who can receive the vaccine become vaccinated. You will help to protect your younger children, as well as older family members, friends, and co-workers by being fully vaccinated. Recent evidence suggests that kids who develop COVID-19 become infected from an adult (vs infecting adults), so having all the adults in a child’s home and school vaccinated decreases the risk of the child becoming infected.