COVID-19: Vaccines for 6 Months to Under 5 Years Old

Last updated: March 7, 2023

Pediatric Moderna Spikevax (25 mcg) and pediatric Pfizer- BioNTech (3 mcg) vaccines for children 6 months to under 5 years of age are available. Parents/caregivers can book appointments online or visit a mobile vaccination clinic near you. The COVID-19 vaccines can be given at the same time as other vaccines.

 

As the weather gets colder and people spend more time indoors, there is an increase in COVID-19, flu and other respiratory virus activity. Vaccination, including the COVID-19 and flu vaccine, is one of the most effective ways to protect our families, communities and ourselves against COVID-19. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19.

All children aged 6 months and up are eligible to receive a COVID-19 vaccine. Children must be at least 6 months of age at the time of vaccination.

A primary series is considered complete when either:

  • two doses of pediatric Moderna (25 mcg) are given at 8 weeks apart; or
  • three doses of pediatric Pfizer (3 mcg) are given at 8 weeks between doses.

Note: The series must be completed with the same vaccine.

For children who are moderately to severely immunocompromised, the monovalent Moderna (25mcg) is preferred and recommended by NACI. This will allow children to complete their primary series after three doses instead of the four doses needed with the monovalent Pfizer-BioNTech (3mcg).

The pediatric mRNA COVID-19 vaccines can be given at the same time as (i.e same day) or any time before or after a different vaccine. Speak to a health care provider about the benefits and risks.

Parents/guardians may choose one of these vaccine products at the time of vaccination. It is not recommended to mix products for your infant or child’s primary series doses. Your child should receive the same product for all their primary series doses, whether it is Pfizer or Moderna.

4 and 5 year old vaccination

  • Children aged 4 who will turn 5 years of age between their doses in their primary vaccine series should receive their age-appropriate dose at the time of the vaccination. The interval between doses is determined by the child’s age at the start of the vaccination series.

5 and 6 year old vaccination

  • Both the pediatric Moderna Spikevax (25 mcg) COVID-19 vaccine and the pediatric Pfizer-BioNTech Comirnaty COVID-19 vaccine (10 mcg) are authorized for children who are 5 years of age.
  • It is still preferred for children who are 5 years of age or older to receive the pediatric Pfizer vaccine.
  • See Ministry of Health COVID-19 Vaccine Administration (Chapter 2: Moderna COVID-19 Vaccine)

To make the best decision for your family, contact your health care provider or call the Provincial Vaccine Contact Centre at 1-833-943-3900 to speak with a health specialist. Parents/caregivers can also book a confidential phone appointment with a SickKids Registered Nurse through the COVID-19 Vaccine Consult Service or the Scarborough Health Network’s VaxFacts Clinic to speak with a doctor.

  • Unvaccinated individuals are at the highest risk of severe illness and hospitalization for COVID-19 infection, including in children.
    • In Toronto, 201 children under the age of 5 have been hospitalized due to COVID-19, 13 have been admitted to ICU and sadly, 2 children have died within this age group [based on data up to September 27]
    • In Ontario, 1,290 children under the age of 5 have been hospitalized due to COVID-19. Over 100 children have been hospitalized since the last report from July 16, 2022. [Based on data as of September 17].
    • Hospitalizations are highest in the youngest ages compared to other children.
  • COVID-19 can spread very easily. Children infected with COVID-19 and its variants can spread it even if they do not develop symptoms. Most children who get infected with COVID-19 do not usually get very sick. However, some children have developed serious illness and needed hospitalization, even if they did not have other health conditions.
  • Studies from British Columbia and Quebec suggest that many children under the age of 5 have had COVID-19, with the majority of infections occurring when Omicron became the dominant variant.
  • COVID-19 infection in children may lead to rare but serious health issues, including:
    • Myocarditis or pericarditis (heart inflammation)
    • Multi-system Inflammatory Syndrome in Children (MIS-C), a serious inflammatory reaction that occurs about four weeks after having COVID-19. It often requires hospitalization or ICU admission.
  • Even with mild symptoms, children can develop a condition called long COVID where they have symptoms weeks or months after getting COVID-19 including shortness of breath, severe tiredness, difficulty concentrating, and more.

Getting the vaccine is the best way to protect children and people around them from COVID-19 related illness, hospitalization and death.

Learn more about the benefits of the COVID-19 vaccine.

The more young children who are vaccinated, the safer daycare, school, and other social activities will be. It will help reduce the risk of outbreaks, and prevent disruptions of important social activities. Getting vaccinated after a recent COVID-19 infection can provide longer lasting immunity.

The pediatric vaccines are effective and safe for young children.

Health Canada performed a thorough review of the pediatric Moderna and pediatric Pfizer vaccines and determined that the benefits of this vaccine outweigh the risks for children in this age group.

Clinical trial findings

It is important to note the clinical trials evaluating the pediatric Moderna dose (25 mcg) and the pediatric Pfizer (3 mcg) vaccines took place in Canada and the United States when Omicron was the main variant infecting people.

Pediatric Pfizer (3 mcg):

The National Advisory Committee on Immunization (NACI) recommendation for this vaccine is pending. Health Canada reviewed the clinical trials to determine the effectiveness data on the pediatric Pfizer (3 mcg) vaccine for children ages 6 months to under 5 years.

The clinical trial showed:

  • The immune response among children under 5 years old for the pediatric Pfizer 3 dose primary series, compared favorably to that of 2 doses among 16 to 25 year olds.
  • The efficacy of the vaccine in preventing symptomatic COVID-19 was 80.3% in children aged 5 years old and under.
  • No new safety concerns were identified.

Pediatric Moderna:

The NACI recommendations to approve this vaccine were based on:

  • Reviewed clinical trial data on the safety, efficacy and immune response produced by the vaccine
  • The spread and severity of COVID-19 in children under the age of 5.

The clinical trial showed that children under 5 years of age who received the pediatric Moderna 2 dose primary series:

  • Produced an immune response equaling the response seen in young adults 18 to 25 years of age, who received the 100 mcg 2 dose primary series.
  • The efficacy of the vaccine in preventing symptomatic COVID-19 was 50.6% in children 6 to 23 months of age and 36.8% in children 2 to 5 years of age, starting 14 days after the second dose.
  • The pediatric Moderna COVID-19 vaccine was well tolerated by young children.

With both vaccines, there were NO cases of myocarditis or pericarditis. Both vaccines are great options producing high levels of immune response.

NACI, Health Canada and PHAC will continue to closely monitor real world data from the use of this vaccine for potential rare and very rare side effects.

Vaccine side-effects in young children

Common COVID-19 side effects in young children are similar to those seen in adults. Side effects are usually mild and go away within one to three days. They include:

  • Sore arm near the injection site
  • Feeling tired
  • Headache
  • Achy muscles or joints
  • Fever and chills

COVID-19 vaccines and reproductive health

There is no evidence the COVID-19 vaccines impact fertility, long-term menstrual irregularities, puberty, or normal growth and development.

It is recommended that children still complete their vaccination series and booster if eligible, even after a COVID-19 infection. Immunity from an infection may not last and people can get COVID-19 again. For recommendations on when to get a COVID-19 vaccine, see Previous COVID-19 Infection.

If the child is a close contact of someone with COVID-19 infection, they can get vaccinated as long as self-isolation (if required) is complete, and they are free of symptoms or their symptoms have resolved.

City-run and mobile clinics

All City-run clinics are able to offer accommodation, including support for babies and children. Each clinic has parking near the entrance, ramps, elevators, and wheelchairs.

Staff are also on site at each clinic to support as necessary. Clients who need a care provider or service animal with them will be accommodated. There are also privacy rooms available upon request.

COVID-19 vaccines are also available to eligible residents 6 months and over at select mobile vaccination clinics.

Pharmacies

Children 6 months and older may be vaccinated at a local pharmacy. Most pharmacies book appointments ahead of time and some allow walk-ins.

Check with the pharmacy before you go to confirm:

  • If an appointment is needed
  • Vaccine products available
  • Minimum age they will vaccinate a infant/child

For more information and locations, please visit the Ontario government’s webpage for COVID-19 pharmacy vaccine locations.

Family health teams and physicians/paediatricians

Select health teams, physicians and paediatricians provide COVID-19 vaccinations in their clinic. Doctors will contact their patients directly if they are participating and will direct you on how to book your appointment.

Specialized accommodations/clinics

The Hospital for Sick Children

For children requiring medical vaccination support, SickKids can help coordinate their COVID-19 vaccination appointment and offer specialized services including drive-through vaccination and the availability of Child Life Specialists and paediatric vaccinators.

SickKids will be running specialized vaccine clinics at the SickKids COVID-19 Testing, Vaccination and Community Outreach Centre (CTC) for children aged six months to under five years old who require additional support for their COVID-19 vaccine due to medical reasons (e.g., medical complexity, needle phobia).

When: Wednesdays between 10am to 3pm (by appointment only)

Where: On site at SickKids through the 555 University Ave entrance

How to book:

Routine immunization for infants and toddlers is still important during COVID-19. Vaccine preventable diseases are still spreading globally. Waiting to vaccinate can leave children vulnerable to diseases. Vaccines should only be postponed if your child is sick with respiratory symptoms to prevent any possible spread of COVID-19.

Children 6 months and older may receive a COVID-19 vaccine at the same time as, or at any time before or after any other vaccines, including the flu shot.

For more details, see:

Vaccines given with a needle can be painful and frightening for a child. No parent/guardian wants to see their child in pain, however a there are steps you can take to help reduce pain for your child.

For infants and babies, consider:

  • Cuddle your baby on your lap.
  • Remove baby’s clothing to expose the arms or legs for the needle.
  • Distract your baby with singing, breastfeeding or toy rattles.
  • Breastfeeding before, during and after the needle provides comfort to parent and baby.
  • For non-breastfed babies, give a few drops of sugar water before and after the needle. Do not use sugar water at home to calm upset or crying babies, as this can lead to tooth decay.
  • After breastfeeding or sugar water, wipe baby’s mouth with a damp facecloth.
  • Using a topical cream, gel or patch to numb the area where the needle will be given
  • Try to stay calm by taking a few deep breaths yourself. Children see and feel what their parents/caregiver are doing and often do the same.

For children under 5 years of age, consider:

  • Talk to your child about the health visit.
  • Your child may feel a “poke or pinch” for a few seconds.
  • Work on a plan together.
  • Have your child choose a favourite blanket, stuffed animal, a book or toy that will distract or bring comfort.
  • Hold your child on your lap in a comforting hug.
  • Blow bubbles or take deep breaths together so the belly expands.
  • Use distractions: sing, read a book or use a hand held device.
  • Offer praise. Positive reinforcement works for kids of all ages.

More Resources:

COVID-19  Vaccines and Children: Update Session for Parents and Guardians

Presented on Wednesday, September 14, 2022 by Dr. Vinita Dubey, Associate Medical Officer of Health, this webinar covered:

  • Risk for COVID-19 in children
  • Vaccine safety & benefits
  • Fall boosters for children
  • Ways to reduce COVID-19 spread

View the presentation recording and slideshow.

COVID-19 Update Session for Toronto’s Childcare Sector

COVID-19 vaccination has now been approved for children 6 months to under 5 years of age. Staff and volunteers from Toronto’s childcare and early learning sector are invited to attend a webinar that will provide up-to-date information about:

  • Benefits of vaccination in children
  • COVID-19 vaccine for young children and Fall boosters
  • Monkeypox and risk for children
  • Reducing COVID-19 spread

This session will be presented by Dr. Vinita Dubey, Associate Medical Officer of Health, and includes a question and answer period.

Session 1 took place on Monday, September 19, 2022. View the presentation recording and slideshow.

Session 2 took place on Thursday, September 22, 2022. View the presentation recording and slideshow.