411 Pediatrics & After Hours Care

Wondering how to get your baby to sleep through the night? Struggling to get your newborn to sleep anywhere but on you? Wishing your baby would have a regular nap schedule? Wondering how to avoid the dreaded 4 month sleep 'regression'? Wondering when is the right time to stop those night feedings? Wondering If you will ever sleep through the night?

We have the answers to these burning questions and yes, we can help everyone sleep through the night!

Here is the one online class you need and have been waiting for: our Sleeping Through The Night Masterclass! https://store.draribrown.com/sleep-masterclass

Sleeping Through The Night Masterclass *Establish healthy sleep routines for 0-1 year of age *Get your little one to sleep through the night in 5 easy steps *Break unhealthy habits and everyone gets more sleep! *This sleep course delivers honest, reality and evidence-based tips from noted developmental pediatrician and Baby 411 author, D...

Having a baby soon? Feel clueless/anxious about caring for a newborn? You are not alone and we're here to help! Check out our newborn care masterclass to learn what you really need to know to feel more prepared and confident such as:
- What's That In my baby's diaper?!
- Breastfeeding tips and tricks
- Why Is my baby so rashy and should I worry?
- Crying and soothing your newborn?
- Will I ever get sleep again? And much, much more!
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Newborn Care Masterclass Get the most recent updates, research, and recommendations on newborn care, nutrition, breastfeeding, sleep, baby p**p, and more. Learn to trust your parenting instincts with actionable guidance and unbiased advice. No fluff, only real talk so you can make the best decisions for your baby. *Limited....

Welcome to 411 Pediatrics! Watch our meet and greet video to learn more about our practice! https://www.youtube.com/watch?v=equ0oOxK-oA

411 Pediatrics: Caring for Austin Tx kids since 2013. Drs. Ari Brown, Cacey Adams, & Ava Gallagher Welcome to 411 Pediatrics! We'd like to show you around and introduce you to our amazing staff. For more info, visit 411pediatrics.com. For more info on our ...

Social media has changed the way we parent... and infinitely raised our anxiety levels! My POV as a pediatrician in the trenches. https://www.kxan.com/news/local/how-has-social-media-changed-the-way-we-parent-austin-pediatrician-weighs-in-on-recent-study/

How has social media changed the way we parent? Austin pediatrician weighs in on recent study “I think that at a certain level you actually are a better parent because you have more access to information. The problem is that access can also create a lot of anxiety and send you down th…

COVID-19 Vaccine Update

We should receive our shipment of the Pfizer vaccine for children ages 6 months—5 years of age soon! We will start with the quick highlights, but please read the entire update for details.

The Highlights
• On WEDNESDAY, JUNE 29, we will begin booking vaccine-only nurse appointments BY PHONE.
• Please call during weekday office hours to schedule.
• FYI we are closed on Monday, July 4th, for the holiday.
• Do not call on the weekends or after hours for COVID-19 scheduling.
• Do not email or portal message for COVID-19 scheduling.
• We will offer vaccine at both nurse visit appointments and at well child visits.
• If your child has an upcoming well child visit, please call to let us know if you want them to receive COVID-19 vaccine at that visit. We will reserve a dose for your child.
• We are currently offering the 3-dose Pfizer vaccine only.
• If your child had a COVID-19 exposure within the past 5 days, please wait to see if they develop an infection and have a negative home COVID-19 test prior to scheduling the vaccine.
• If your child has had a recent COVID-19 infection, we advise waiting for a period of 3 months before getting COVID-19 vaccination (primary or booster doses). More info in the details section below.

Can't wait? You have options!

>Texas Children's Hospital has Pfizer vaccine, by appointment only at Austin outpatient clinic.
>Dell Children's Medical Center has Pfizer vaccine, at a walk-in, no-appointment clinic at 4900 Mueller Blvd for all kids 6 months and up, on Wed June 29 5-8 pm.
>Tarrytown Pharmacy offers both Moderna and Pfizer vaccine for children under age 5. Children under 3 need a prescription from their pediatrician for pharmacies to administer it. For your convenience, we have prescriptions ready-to-go at our front desk. You can stop by and pick one up at your convenience.

The Details
Q. Should my child get the COVID-19 vaccine?
Yes. While most cases of COVID-19 infection are mild in young children, over 440 American children under age 5 have died from COVID-19 since the pandemic began. COVID-19 infection has become a leading cause of death in this age group. And, up to 50% of children who are hospitalized with COVID-19 do not have any underlying medical conditions. The vaccine can protect against serious disease.

Q. Is the COVID-19 vaccine safe for children?
Yes. Over 9000 babies and children participated in the Moderna and Pfizer clinical trials and tolerated the vaccine without significant adverse reactions. And, over 10 million doses of Pfizer vaccine have already been safely given to children ages 5-11. Safety data will continue to be monitored closely.

Q. Are there any long-term side effects?
Very unlikely. Because this is a relatively new vaccine, it is impossible to answer this question with absolute certainty. But mRNA has been studied for over 20 years before the first COVID-19 vaccine came out in 2020. No long-term side effects have been identified. The mRNA vaccine ingredients quickly break down and clear the body within several days. The speculation about chronic health and fertility issues are unfounded and scientifically implausible.

Q. Is the COVID-19 vaccine effective for children?
Yes. It is effective in protecting against severe COVID-19 infection because children mount a robust immune response to the vaccine. It is somewhat protective against infection, but the main goal is protection against serious illness and death.

Q. Can COVID-19 vaccine be given at the same time as other vaccinations?
Yes. Several vaccines are co-administered in the routine childhood vaccination series without compromising the immune response or causing significant adverse reactions. There are no concerns for giving COVID-19 vaccine and other shots simultaneously.

Q. Is there any difference between Moderna and Pfizer vaccine?
Both vaccines use mRNA technology. Both vaccine clinical trials demonstrated that young children mount an antibody response to vaccination. Both vaccines proved to be safe, without significant adverse reactions in young children.

The current Moderna vaccine series for young children is 2 doses, given 28 days apart. Children develop an immune response 14 days after the 2nd dose. It is about 37% effective* in reducing the rate of infection (*but remember, the main goal is reducing severe disease). Moderna intends to submit data on adding a 3rd dose to the vaccination series next month.

The Pfizer vaccine series for young children is 3 doses, with the first two doses given 21 days apart and the 3rd dose given 2 months later. Children develop an immune response 7 days after the 3rd dose* (*there is no significant protection until the 3rd dose is given!) It is about 80% effective in reducing the rate of infection in the limited number of children in the study who received all three doses.

Q. Why is your office only offering Pfizer vaccine?
We will offer one vaccine brand for simplicity in scheduling and administering the vaccine. Pfizer vaccine is, and Moderna vaccine will eventually be a 3-dose series (Moderna plans to submit data to the FDA next month for a 3rd dose to be added). Both mRNA vaccines are effective in protecting against severe disease. But in this pandemic, everything evolves based on scientific data. If Moderna proves to be superior in protection, we will certainly offer it.

Q. Can my child get the vaccine if they already had COVID-19 infection?
Yes, and we encourage it. Based on recent studies, we know that children do not mount a robust or sustained immune response (lack of antibodies and T cell response) after infection. Getting the vaccine will boost their protection from serious illness with COVID-19.

Q. Can my child get the vaccine if they had COVID-19 infection recently?
Yes, as long as they have recovered from the acute illness. However, recent data suggests that your child may have a better immune response to the vaccine if 3 months have passed between infection and vaccination. For now, we recommend waiting 3 months after infection.

Q. What if they get the first dose of vaccine and then get COVID-19 infection before their 2nd or 3rd dose?
Based on current data, we recommend waiting 3 months to resume the vaccination series if your child has a COVID-19 infection between doses.

Q. What if my child turns 5 during the COVID-19 vaccination series?
Your child will receive the dose and vaccination schedule according to their age, which may change if their birthday occurs during the vaccination series.

Have more questions? Send us questions via the patient portal! We will continue to post breaking news on our website and on Instagram .

Happy summer and 4th of July!

411 Pediatrics

January 2022: COVID19 Update

It’s a new year and here we are, still dealing with this pandemic. We are all pretty tired and feeling a bit defeated by a tiny virus. But as we reflect on the past two years, we really have come a long way with both prevention and treatment options. That gives us hope for the future.

Here are the latest updates:

1. What do I need to know about the Omicron variant?
The new Omicron variant arrived in the US on December 1 and is circulating rapidly across the US. It is twice as contagious as the Delta variant, which itself, is extremely contagious! The incubation time is also shorter—on average, it takes about 3 days to become infected after exposure to the virus.

2. Does the Omicron variant cause milder illness?
Yes, we think so. Omicron may be a milder strain because it seems to prefer infecting the nose and throat more than the lungs. But, there are other possible reasons it may be less severe. Vaccinated people experience more breakthrough infection with Omicron than Delta. And, vaccinated people have milder illness because they are vaccinated...thank you, vaccine! In South Africa, younger people were infected, and some already had one COVID19 infection prior to Omicron so that may also explain the milder cases. What we do know is that hospitalization rates are rising so this variant should still be taken seriously. And, most hospitalized patients are unvaccinated.

3. Since Omicron and Delta variants are everywhere right now, what should we do?
Avoid large indoor gatherings, mask up in public, and get vaccinated/boosted. Yes, your child should return to school but please have your child wear a high quality, well-fitting mask (N95, KN95, KF94 if possible), and if age 5 and up, please get your child vaccinated.

4. Are children getting COVID-19 infection?
Um, yes! We have seen significantly more patients (as young as 8 months old) test positive with COVID19 infection in the past two weeks. Most of our patients with COVID19 infection experience mild symptoms. Honestly, it is very hard to predict who has COVID19 and who has a garden variety cold virus, flu, Strep throat, or seasonal allergies. Kids with COVID19 may have fever, or no fever, sore throat, body aches, headaches, dizziness, congestion, and cough. With this surge in cases, we assume nothing and test everyone who has symptoms or a known exposure.

The percent of American children with COVID19 infection being ill enough for hospitalization is stable (0.1-1.8%) but the number of hospitalizations are up due to the sheer number of children becoming infected. And, some hospitalized children are diagnosed with COVID19 while hospitalized for another reason. Children with underlying medical conditions are still at the greatest risk of having serious illness with COVID19. Most children who are hospitalized for COVID19 are unvaccinated. There have been almost 6000 cases of MIS-C (Multisystem Inflammatory Syndrome in Children) and 52 deaths. There is still no clear reason why some children have this severe complication after COVID-19 infection.

5. Should 12—15 year olds get a 3rd dose/booster dose of Pfizer vaccine?
Yes, the FDA is expected to approve a 3rd (booster) dose for this age group next week. And, while official recommendations are pending, the advice will likely be to give the 3rd dose FIVE months after the 2nd dose. Data from Israel suggests that giving the 3rd dose around 4 to 4.5 months after the 2nd dose offers a more robust immune response.

6. What are the new CDC quarantine guidelines?
The Centers for Disease Control changed their quarantine guidelines to 5 days of isolation and then another 5 days of masking around others IF a person with COVID19 is symptom-free or symptoms are resolving. CDC Director, Dr Rochelle Walensky, says 85-90% of people are most contagious in the 1-2 days prior to symptoms and 2-3 days after symptoms begin.

[The scientific community has given very mixed reviews over this new guidance. My take: There are many factors that led to this change and it would have been nice for the CDC to show the scientific data supporting it. The period of contagiousness may not be the same for everyone. Vaccinated people with breakthrough infections are probably shedding less virus for a shorter period of time than unvaccinated people.]

If you test POSITIVE
-stay home and isolate for 5 days
-if you have no symptoms after 5 days (“or symptoms are resolving”), you can leave your home but wear a mask around others for another 5 days
-if you still have a fever, STAY HOME
[While the CDC has no guidance on negative rapid testing prior to return to work/school, some experts believe it would be useful to reduce transmission rates!]

If you are fully vaccinated (3 doses of Pfizer/Moderna or 2 doses less than 6 months ago or 2 doses of J and J) and EXPOSED
-wear a mask for 10 days
-test on day 5, if possible

If you are not fully vaccinated or unvaccinated and EXPOSED
-stay home for 5 days
-wear a mask for 10 days
-test on day 5, if possible

7. Is rapid COVID19 testing accurate?
Yes, a positive test is useful. But there will be more false negative rapid antigen tests with Omicron (i.e. you have COVID19 but the test fails to detect it)…the FDA recently cautioned that the rapid tests are less sensitive to identifying the Omicron variant. If you have symptoms of COVID19 and have a negative rapid test, try to do a second rapid test in 24-36 hours. Or, get a PCR/molecular test and stay home until those results are back.

8. When will the Pfizer vaccine be available for 2-5 year olds?
Not any time soon, unfortunately. The Pfizer study used the lowest dose of vaccine (3mcg) possible to achieve an immune response. That dose was effective for the younger kids (6 months to 23 months old) but not for the 2-5 year old group. So, Pfizer will give a 3rd dose of vaccine to the 2-5 year old study participants and then will reassess their immune response. This takes more time. If that does not work, they have to start a new study with a higher dose of vaccine.

9. When will the vaccine be available for kids under age 2?
The Pfizer vaccine dose of 3 mcg was effective for 6 months to 23 month olds in their two dose series trial. However, the plan is to roll out the 2-5 year old vaccine first...so we wait.

10. When will Moderna vaccine be approved for kids?
Moderna vaccine for teens is still in a holding pattern with the FDA due to the theoretical risk of myocarditis as an adverse effect of the vaccine in teenagers. However, Moderna will be releasing the data on their vaccine study in children ages 6 months to 5 years of age in early 2022. It is possible the Moderna vaccine could be approved in this age group before the Pfizer vaccine.

11. Are there any anti-viral medications for kids?
Yes. Children aged 12 and up are eligible for the monoclonal antibody medication, Sotrovimab (*the supply is currently depleted in Texas). And, the FDA recently gave Pfizer’s oral anti-viral drug, Paxlovid, Emergency Use Authorization. Paxlovid is a prescription medication for people at least 12 years of age and 88 lbs with COVID19 infection and are at high risk of severe disease. The medication is taken as soon as symptoms arise. In studies of unvaccinated people, the risk of hospitalization and death was reduced by 89% if the medication was started within 3 days of symptoms. Note: There are only 65,000 doses of Paxlovid available right now. Pfizer hopes to produce another 200,000 treatment courses in January.

We hope you were able to celebrate the season with your family and friends! We wish you a healthy 2022!

Dr. Ari Brown and the 411 Pediatrics Team

411 Pediatrics & After Hours Care updated their business hours.

Please read! COVID-19 Vaccine for kids 5-11…so how do we get it?!

On Tuesday, the Centers for Disease Control advisory panel unanimously recommended the Pfizer COVID-19 vaccine for kids 5-11 and the CDC director approved this recommendation. We know your next question: where and when can your child get it?! Please read the important content below but to cut to the chase: we will start accepting phone calls on November 9 to book a COVID-19 vaccine appointment.

1. Yes, we are authorized vaccine providers and will offer it to 411 patients only.

2. No, we are not creating a waiting list in anticipation as it only adds more phonecalls both ways. Thank you for your understanding and do not call/email/portal message us today.

3. Yes, on NOVEMBER 9--we will begin scheduling COVID-19 vaccine appointments BY PHONE ONLY. The office opens at 8am and we anticipate a very high call volume, so again, thank you for your patience!

4. Yes, there are other vaccine providers in the area who will offer the pediatric COVID-19 vaccine. Those include: Texas Children’s Specialty Care in Austin, Tarrytown Pharmacy, and CVS. Some school districts are also participating in vaccination efforts.

Want more details?

Info on the CDC Advisory Panel (ACIP) Meeting: Children ages 5-11 can and do become ill/seriously ill from COVID-19 infection. Modeling predictions suggest 600,000 fewer infections over the next four months alone if this age group gets vaccinated, dampening a resurgence and reducing school closures. This is a key reason for moving forward with vaccination now, instead of waiting say, another six months for more data. The safety and efficacy data from the Pfizer study was encouraging and no serious adverse reactions were detected.

Here is the FDA vaccine fact sheet. https://www.fda.gov/media/153717/download

www.fda.gov

Important Updates on COVID-19 vaccine for 5-11 and flu vaccine

Flu vaccine clinic
Our next Saturday flu vaccine clinic is November 6 from 9am—1pm. Please call the office to schedule an appointment. We have flu shots for our patients and their parents.

****COVID-19 vaccine for 5-11-year-olds****

Will you offer the COVID-19 vaccine in your office?
Yes, we will have COVID-19 shot clinics similar to our flu vaccine clinics. Stay tuned for another email with specific clinic dates. We will also post on our website banner at 411pediatrics.com and on Instagram . We know you are excited, and we are too. But, we do NOT have the specific 5-11 year-old pediatric vaccine in our possession yet. So we are NOT making a waiting list for vaccine appointments. See more below...

Is the Pfizer vaccine approved for ages 5—11?
Almost. The FDA (Food and Drug Administration) advisory panel met on October 26 to review the study result findings. The 18 member panel voted overwhelmingly (17 yes, 1 abstention) to approve the vaccine for use in ages 5-11 based on the benefits of vaccination vs the potential risk of infection and risk of adverse side effects with vaccination. But, this is not the end of the regulatory process.
Next steps: the FDA itself has to approve emergency use authorization (which could happen in the next few days). Then, the CDC (Centers for Disease Control) advisory committee will meet (tentatively November 2-3) to make formal recommendations. Finally, Dr Rochelle Walensky, Director of the CDC, needs to sign off after that.

When will the Pfizer vaccine be available for ages 5-11 in your office?
We have pre-ordered 300 doses from the Texas Department of State Health Services (DSHS) for our initial shipment but there is no confirmed shipment date yet due to the regulatory process currently underway. We do not know when it will arrive, but trust us, you will hear as soon as we do know.
While it is tempting to simply use the adult formulation of the vaccine and draw up 1/3 of the volume for the younger children, it ‘has not been studied’ and is discouraged by DSHS. Yes, we have thought about it as we have that vaccine in the office already, but will follow the protocol so we can remain state vaccine providers!

What are the current stats for kids and COVID-19 infection?
Based on data from the American Academy of Pediatrics, Children’s Hospital Association, and the Centers for Disease Control, about 6.2 million children have tested positive for COVID-19 infection, more than 65,000 have been hospitalized, and 718 have died. About 70% of the children hospitalized for COVID-19 infection have pre-existing health conditions such as obesity, diabetes, asthma/chronic lung disease, heart disease and immunosuppression.
In the week ending October 14, there were 131,000 new cases in children, and kids now represent 25% of all new COVID-19 infections in the United States. Children ages 5—11 represent 39% of pediatric COVID-19 infections under 18 years of age.
Most children recover within 1-2 weeks but some will have long term symptoms lasting weeks or months. Since May 2020, there have been 5217 reported cases of Multisystem Inflammatory Syndrome in Children (MIS-C) and 46 deaths. Half of those cases were in children ages 5—13.
The FDA advisory panel that met on October 26 commented that about 40% of the pediatric population in ages 5-11 may have already had symptomatic or asymptomatic COVID-19 disease.

What are the results of the Pfizer vaccine study for ages 5—11?
2268 children participated in this study and most were followed for at least two months after receiving the second dose. There are an additional 2369 children who have yet not completed the follow up portion of the study at the time of application to the FDA. Of the participants, 2/3 received the vaccine and 1/3 received the placebo. Groups were given different doses of the vaccine (10, 20, and 30 mcg) to determine the lowest dose needed to mount adequate antibodies with the least unpleasant side effects (pain at the injection site, fatigue, headache). The 10 mcg dose (1/3 the adult dose) was just as effective as the higher doses in the 5—11-year-olds with only mild side effects, so this will be the recommended dose in this age group. There were no cases of myocarditis, severe allergic reaction or death.
Note: the risk of myocarditis in older age groups (12 and up) is so rare, it would be difficult to detect in the number of kids involved in this study. The FDA advisory committee commented that it is critical to follow the safety data once vaccination is widespread in this age group but that myocarditis (from any cause) is very uncommon in children who have not gone through puberty yet.
Over 90% of children were protected against symptomatic infection during the course of the study. There were 19 cases of COVID-19 infection but only 3 of those were in the vaccinated group (16 were in the placebo group).
Here is the FDA briefing document if you want the in-depth analysis.

If my 10-year-old weighs the same as my 12-year-old, why is the vaccine dose 1/3 strength?
Key point: younger children mount a more robust immune response to vaccinations than older kids and adults because the immune system gets old (and a little weaker) as we get older.
The vaccine dosing is based on the AGE of the child (and the age of their immune system), NOT on the WEIGHT of the child. So even if a 10-year-old weighs the same as a 12-year-old, the 10-year-old will still get the lower dose of Pfizer vaccine.

Is the vaccine schedule the same for kids as adults?
Yes, it is 2 doses given 21 days apart.

Is there any other place vaccine will be available for 5—11-year-olds?
Austin Public Health plans to offer some vaccine clinics through the local school districts. Pharmacies may also offer the vaccine for certain age groups.

Where can I get more information about the vaccine and safety data?
Since we have covered most of these questions on past newsletters, you can always review the news blog on our website at 411pediatrics.com. The American Academy of Pediatrics also has a helpful link here with answers to frequently asked questions.

We will be in touch soon....Happy Halloween!

Flu vaccine is here! Check out our website for details at 411pediatrics.com. We are booking appointments for Saturday clinics on Sept 25 and Oct 9 for patients and their parents now.

We just received 60 doses of Pfizer COVID-19 vaccine! We will offer it to our patients 12-18 years of age by appointment only on Wed Sept 15 and Thurs Sept 16 from 3:30-4:30pm. Please call the office to schedule!

We will be getting more supply in the coming months, when more of our patients are eligible to receive it.

FYI: our flu vaccine shipment has NOT arrived yet, but we will let you know as soon as it does and will resume our Saturday flu vaccine clinics at that time.

Back to School: if your child has symptoms of illness, stay home and please get them tested.
https://www.kvue.com/article/news/local/kids-covid-19-coronavirus-school-tips/269-0f38d4eb-724c-455d-813d-a7d56fe823cd?amp_lite =_

Kids and COVID-19: Pediatrician urges extra vigilance as school year begins Dr. Ari Brown, an Austin pediatrician, said it's an important time for parents to be strong advocates for their children going back to school.

COVID-19 Update from 411 Pediatrics: August 2021

Welcome back to another information-packed COVID-19 update! We know you have lots of questions. If we miss something, let us know and we will try to cover it on Instagram .

A few quick notes before we tackle the questions:

*We require everyone to wear masks in the office, even if you are vaccinated. Most of our patients are too young to be vaccinated and we need to protect them.

*Our COVID-19 Pfizer vaccine supply is coming soon (really!) See more below.

DELTA VARIANT

How contagious is the Delta variant of COVID-19?

Very! The Delta variant is twice as contagious than the original Alpha strain because infected people have a much higher number of viral particles in their nose, which are transmitted into the air. One Delta-infected person can infect 8-10 other people. The incubation period between exposure and infection also seems to be shorter (3-5 days on average). And, people may shed viral particles for a longer period of time.

Is the Delta variant causing more serious infection?

Yes. Anecdotally, medical providers are reporting that hospitalized patients are younger than in previous surges, become more ill, and experience more rapid deterioration with the Delta variant.

Do we need to take special precautions or change our vacation plans?

When Delta (or any future variant) circulates at high levels in our community/country, it’s important to be more vigilant. Observe social distancing, avoid large gatherings indoors, and mask up (everyone—vaccinated or not) when attending a group indoor activity with non-household contacts. Assess your family’s individual risk (immunocompromised, young children, vacation destination) to decide on your vacation plans.

Are the current vaccines effective against the Delta variant?

Yes! The goal of vaccination has always been to protect against severe disease or death from COVID-19 and all three COVID-19 vaccines do that. Most people (97%) hospitalized or dying from COVID-19 are unvaccinated. Delta variant is different because more vaccinated people are getting infected with it and are more likely to spread it to others compared to the original Alpha strain. Most vaccinated people who experience COVID-19 infection have mild symptoms or are symptom-free, which is the true goal of a successful vaccine.

If my child is infected and does not have symptoms, do they still need to isolate?

Yes. It is true that many children have mild/no symptoms with COVID-19. However, they are still capable of shedding the virus and infecting others. All people who test positive for COVID-19 should isolate for 10 days after the onset of symptoms (or a positive test result).

_______________________________________________________________
VACCINES

Does your office have COVID-19 vaccine yet?

No, but we should receive our first shipment of the Pfizer vaccine in the next few weeks! We will be ready to go when the vaccine is approved for kids ages 5 and up. Because of logistical issues and our desire to avoid wasting vaccines, we will run special COVID-19 vaccine clinics (like our flu shot clinics) and offer vaccine at specific times during the regular office hours. Stay tuned!

When will kids under age 12 be eligible for COVID-19 vaccine?

Pfizer is the closest to completing their COVID-19 studies in children. Initially, Pfizer divided the study of over 4500 participants into three different age groups. The FDA recently requested Pfizer (and Moderna) to include a minimum of 3000 study participants in each age group and four to six months of data, which explains why it is taking so long to see these results. The participants received varying doses of the vaccine based on their age:

6 months to under age 5 years receive 3-mcg dose

5 years up to 11 years of age receive 10-mcg dose

By comparison, the dose for 12 years and up is a 30-mcg dose.

Pfizer expects to have safety and immune response data on the 5 to 11 year olds in September and will seek FDA Emergency Use Authorization at that point. The 2 to 5 year old data will be released soon after, but the infant and toddler data will be available closer to the end of 2021.

We want our child vaccinated before school starts. Can we cheat and get our 10 or 11 year old vaccinated before FDA Emergency Use Authorization?

This is a very common question and the official answer is no. But, because tweens and teens vary in their pubertal development, some 10 or 11 year olds are at the same weight or physical maturation of some 12 year olds. So, presumably they would do fine with the 30-mcg dose. But Pfizer’s current vaccine study is using a 10-mcg dose (1/3 of the adult dose) for the 5 to 11 year olds. That does not mean it is risky to give the higher dose to a 10 or 11 year old, it just means we don’t know. When we receive our vaccine shipment, we will follow the CDC/FDA guidelines because we have to document the vaccination into the state immunization registry with your child’s birthdate.

What is the risk for myocarditis?

The numbers are very low for heart inflammation after vaccination (13/1 million) and most cases are mild and self-resolving. And, know that COVID-19 infection can also cause myocarditis. A JAMA article showed that 15% of athletes in the study experienced myocarditis even after mild infection. Infectious disease experts feel that vaccination is definitely the safer choice.

Would it be safer to just give 1 dose of mRNA (Pfizer) vaccine since myocarditis is seen more after the 2nd dose?

No. The first dose of mRNA vaccine primes the immune system to recognize the virus. The second dose increases the antibody response by over 10 times, which is needed for prolonged immunity.

Is there a concern for long-term side effects with vaccination?

No. With all vaccines, untoward side effects and adverse reactions occur within two months of being vaccinated. While anti-vaccine activists blame vaccines (including COVID-19) for chronic health conditions and infertility, there is no data and no plausible science to support these concerns—even for vaccines that have been used for decades. Over 161 million Americans received COVID-19 vaccine over the past seven months (and over a year ago for participants in the original vaccination studies). It is unlikely a chronic adverse event will arise now and it is very likely one will get infected if a person is unvaccinated.

Will we need a booster shot?

Probably, but the US has no recommendation for it yet. Pfizer, Moderna, and J & J have excellent protection against severe COVID-19 disease, including the Delta variant. However, studies in Israel demonstrate that the level of immunity may drop after at least six months of receiving the Pfizer vaccine. As a result, Israel recently starting giving booster doses to immunocompromised patients and people over age 60. Remember, the goal of vaccination is to protect against severe disease and the two-dose series still does that. There is no downside to getting a booster (3rd) dose but right now, 97% of hospitalized patients are unvaccinated. Recommendations could change if more vaccinated people become seriously ill.

RISKS

Is it safe for my child to attend preschool/childcare?

This is a challenge with no easy or risk-free answer. It will be several months before the youngest children (6 months to 2 years of age) can be vaccinated. There have been several COVID-19 outbreaks in local preschools over the past few weeks. The delta variant is significantly more contagious, more young children are getting infected, and they are spreading it. Most children have mild illness compared to adults, but some children are ill enough to require hospitalization so their health outcomes should not be ignored. If your toddler (under age 3) goes to preschool purely for socialization and developmental stimulation, consider that toddlers may enjoy preschool, but they don't need it. They need a loving caregiver who will provide developmental stimulation. So, your child will be developmentally fine either way. Kids who are 3 and 4 years of age do benefit from preschool, so this deserves more careful risk/benefit consideration. If your child attends daycare, it’s appropriate to ask if all the caregivers are vaccinated and if mask policies for staff are in place.

Should my child wear a mask in school?

Yes. It is the safest thing to do for optimal protection. Our kids really need to be in school and the most effective way to have them there safely is for them to wear masks, especially since most of them are too young to be vaccinated right now.

What are the current stats on COVID-19 disease in children?

Cases are rising in children and the Delta variant is more contagious in children. While adults have more infections and deaths, the disease burden in children is significant. To date, over 4 million cases of COVID-19 have been documented in American kids (the actual numbers are probably higher than that). This represents about 14% of the total number of cases in the US. There have been over 400 deaths. In Texas, children’s hospitals are reporting a steep rise in pediatric COVID-19 hospitalizations and ICU admissions in the past month.

We wish the news was better, but stay healthy and we will keep you posted with continued updates.

Dr Ari Brown and the 411 Pediatrics Team