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Before talking about COVID-19 vaccines for children, it helps to take a step back and talk about vaccines in general. Many of us are fortunate to live in a time when serious childhood infections are rare—not because they disappeared on their own, but because vaccines changed the world.
I often think about this when visiting my father’s birthplace in Bosnia and walking through old village graveyard. There are small rows of tiny headstones—children who died from infections that today are almost always preventable. The first vaccine, developed by Edward Jenner to protect against smallpox, transformed medicine and saved countless lives, especially children’s lives.
That history matters. But so does asking questions. Supporting vaccines as a public health achievement doesn’t mean we shouldn’t carefully evaluate each vaccine—especially when it comes to healthy children.
How Vaccines Work (Briefly)
Vaccines train the immune system to recognize and fight infections without causing the disease itself. Over time, scientists have developed different types of vaccines. The COVID-19 vaccines used in children in the U.S. are mRNA vaccines, which give cells instructions to make a harmless piece of the virus so the immune system can learn to respond. The mRNA never enters the nucleus and breaks down quickly after doing its job.
This technology may feel new, but it has been studied for decades and was able to be deployed quickly because of prior research and global investment.
How COVID-19 Affects Children
Most children who get COVID-19 have mild symptoms or no symptoms at all. Common symptoms include fever, cough, fatigue, sore throat, and congestion. Many children who are infected are never tested because they feel fine.
Severe illness in children is rare but does happen. One very uncommon but serious condition is MIS-C, a delayed inflammatory reaction that can occur weeks after infection and may involve the heart and other organs. Children with obesity, metabolic disorders, atopic disorders and cancer at at a higher risk. With prompt treatment, most children recover well.
COVID-19 Deaths in Children: Putting Risk in Context
Hearing that children have died from COVID-19 is understandably alarming. In the U.S., roughly 2,000 pediatric deaths have been attributed to COVID-19 over a span of several years (approximately 3–4 years). While this number is very small compared with adult mortality, it is not zero—and that reality deserves careful examination.
To put this in context, an NEJM Special Report using 2016 data (PMID: 30575483) documented 20,360 deaths among U.S. children and adolescents. More than 60% were due to injuries, followed by malignancies, suffocation, and drowning. Notably, infectious diseases did not appear among the leading causes of death. Instead, congenital anomalies, heart disease, and chronic lower respiratory disease together accounted for about 9%.
Overall, these leading causes have remained relatively stable. A later JAMA report ranked COVID-19 as the 9th leading cause of death in children during 2021–2022. However, in reviewing the available data, I was unable to clearly distinguish deaths caused directly by COVID-19 infection from deaths in children with serious underlying conditions whose illness may have been exacerbated by COVID. There appears to be significant overlap, and this lack of clarity is where the statistics become problematic.
Without clear comparative outcome data—particularly comparing vaccinated versus unvaccinated children, and especially among those without underlying medical conditions—it is difficult to meaningfully assess the risk of vaccination relative to the risk of the disease itself. This gap in the data makes it challenging to fully answer the question many families faced when deciding whether to vaccinate their children.
Which COVID-19 Vaccines Are Available for Children?
In the U.S., the following vaccines are approved or authorized for children:
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- Pfizer-BioNTech: ages 5 and up
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- Moderna: ages 6 months and up
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- Novavax: ages 12 and up
Children receive lower doses than adults. Vaccine testing in children follows a cautious, step-by-step process that starts in adults and moves gradually into younger age groups. Because severe COVID-19 is uncommon in kids, studies focus on whether children develop immune responses similar to adults, rather than waiting for large numbers of severe cases.
Vaccine Safety in Children
Most children experience mild side effects such as a sore arm, fatigue, or a low-grade fever for a day or two. Serious side effects are rare.
One known rare risk is myocarditis, mostly seen in adolescent males after mRNA vaccines. These cases are usually mild and resolve, but they are an important part of the risk–benefit discussion.
Long-term safety continues to be monitored through large national surveillance systems.
A Personal Note on Decision-Making
Based on the data we have, I believe COVID-19 vaccines are likely very safe. That said, I personally chose not to vaccinate my own children against COVID-19. This decision reflects their very low risk of severe disease, my professional background and bias-fear from myocarditis, and the limited long-term pediatric safety data available at this time.
This was not an anti-vaccine decision. My children are fully vaccinated according to routine schedules, including annual flu shots. It was simply a choice made after weighing risks and benefits for our family.
Other families may reasonably come to a different conclusion.
Final Thoughts
COVID-19 vaccination for children is not a black-and-white issue. The vaccines are effective and generally safe, but children are also at lower risk from the disease itself. Parents deserve clear information, honest discussion of uncertainty, and respect for thoughtful decision-making.
If you have questions, talk with your pediatrician—someone who understands your child’s health and your family’s circumstances. Staying informed, asking thoughtful questions, and making careful decisions are among the best ways to protect our children.
Medicine is not absolute. Trust clinicians who are transparent about uncertainty and evolving evidence, not those who speak with total certainty.