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

Last updated: August 18, 2022 at 8:53 a.m.

Health Canada approved the use of pediatric Moderna Spikevax mRNA COVID-19 vaccine for children 6 months to under 5 years of age. This is the only COVID-19 vaccine authorized in Canada for this age group. As of Thursday, July 28 at 8 a.m., parents/caregivers will be able to book appointments.

Currently, the pediatric Moderna COVID-19 vaccine is the only product authorized for children aged 6 months to under 5 years of age. It is half of the dosage of the Moderna vaccine offered to children 6 to 11 years of age.

The National Advisory Committee on Immunization (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

Vaccination 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 now eligible to receive a COVID-19 vaccine. Children must be at least 6 months of age at the time of vaccination.

NACI and the Ministry of Health recommend that:

  • A primary series of 2 doses of the pediatric Moderna vaccine be given, at least 8 weeks apart.
  • For children who are moderately to severely immunocompromised, a primary series of 3 doses of the pediatric Moderna vaccine be given, with an interval of 4 to 8 weeks between each dose.

For children who had a recent COVID-19 infection, it is recommended to:

  • Wait 8 weeks after the start of COVID-19 symptoms or a positive COVID-19 test before beginning or continuing the primary series.
  • This interval may be shortened to 4 weeks for children who are moderately to severely immunocompromised.

For children with a previous history of Multisystem Inflammatory Syndrome in Children (MIS-C), regardless of immunocompromised status, they may receive the vaccine when clinical recovery has been achieved or ≥90 days since the onset of MIS-C, whichever is longer.

The pediatric Moderna vaccine should be given 14 days before or after a different vaccine to help determine the source of any possible side effects. Consult a health care provider if you have any questions.

  • Unvaccinated individuals are at the highest risk of severe illness and hospitalization for COVID-19 infection, including in children.
    • In Toronto, 178 children under the age of 5 have been hospitalized due to COVID-19, 12 have been admitted to ICU and sadly, 2 children have died within this age group [based on data up to July 19]
    • In Ontario, over 1,100 children under the age of 5 have been hospitalized due to COVID-19 [Ontario COVID-19 Data Tool | Public Health Ontario: Data as of July 16]
  • 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 Moderna vaccine is effective and safe for young children.

Currently, the pediatric Moderna vaccine is the only vaccine approved by Health Canada for this age group.

Clinical trial findings

The clinical trial evaluating the pediatric Moderna dose vaccine took place in Canada and the United States when Omicron was the main variant infecting people. The trial found that for children under 5 years of age the pediatric Moderna (25mcg) 2 dose primary series produced an immune response equaling the response seen in young adults 18 to 25 years of age, who received the 100mcg 2 dose primary series.

The clinical trial also showed that:

  • The preliminary efficacy of the vaccine in preventing symptomatic COVID-19 during Omicron was estimated at 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.
  • There were no deaths or cases of severe COVID-19 or MIS-C among trial participants that received pediatric Moderna COVID-19 vaccine. As such, it was not possible to evaluate efficacy against severe COVID-19 or MIS-C.
  • No cases of myocarditis or pericarditis were reported.
  • Clinical trial data shows that pediatric Moderna COVID-19 vaccine was well tolerated by young children.
  • No adverse events (serious side effects) were reported during this trial, however it is important to note that due to the size of the trial, it is unlikely that adverse events that occur at a frequency less often than 6 in 10,000 people would be detected.

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.

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.
  • Please see the Ministry of Health COVID-19 Vaccine Administration (Chapter 2: Moderna COVID-19 Vaccine) for guidance on vaccines that are recommended for children who are 5 years of age and for children who turn 6 after the first dose of their primary series.

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 you can get COVID-19 again. For recommendations on when to get your 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 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.

Hospital Clinics

Mid-West Ontario Health Team, Regent Park 40 Oak, (Fred Victor) and Scarborough Health Network are currently offering pediatric vaccines.

Check with the hospital before you go to see if they offer pediatric vaccines.

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.

Visit sickkids.ca/vaccineconsult to make a booking to speak with a Registered Nurse. If you need assistance booking an appointment, please call 437-881-3505 or toll free at 1-888-304-6558.

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:

Hollandview Bloorview

Holland Bloorview Hospital is hosting a fully accessible, sensory-and family-friendly vaccination clinic for children aged 6 months and up with disabilities and/or complex care needs as well as their siblings, family members and the general public.

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.

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

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

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.

At this time, the pediatric Moderna Spikevax COVID-19 vaccine should not routinely be given concurrently (i.e., same day) with other vaccines. Since this is a newly authorized COVID-19 vaccine in this age group, NACI recommends this COVID-19 vaccine should be given 14 days before or after a different vaccine. This will help to determine if a potential side effect is due to this COVID-19 vaccine or a different vaccine.

A shorter interval between the administration of Moderna Spikevax (25 mcg) vaccine and a different vaccine may be warranted in some circumstances at the discretion of a health care provider.

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.

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