On Tuesday, November 2, the CDC Advisory Committee on Immunization Practices (ACIP) recommended the Pfizer-BioNTech pediatric vaccine for children aged 5 to 11 years. This was the latest hurdle in the race to vaccinate all Americans to help stop the spread of the COVID-19 Delta variant.

To discuss the significance of this approval and to answer questions regarding the role out, risk and benefits, and timing of shots, The Clinical Advisor interviewed Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, a pediatric nurse practitioner and owner of Pediatric Nurse Practitioner House Calls. Dr. Koslap-Petraco is also a nurse consultant for the Immunization Action Coalition and clinical assistant professor at Stony Brook University in New York.

Question: Are you excited about the emergency use authorization of the Pfizer COVID-19 vaccine for children aged 5 to 11 years?

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Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP Credit: Amy Anderson

Dr Koslap-Petraco: I am thrilled that we finally can start vaccinating younger children against COVID-19. I think this has been a long time coming considering the wait since the vaccine was approved for older children and adults. I understand the reason behind [the delay]. We wanted to make sure that we had good evidence showing that this vaccine is safe and effective. This is another step out of this horrendous pandemic.

Question: What do pediatricians, nurse practitioners (NPs), and PAs need to do to prepare for the mass vaccination of school-aged children?

Dr Koslap-Petraco: I think we’ve all been preparing for this, making sure that we have enough materials and supplies and preordering doses of the vaccine. Here in New York State, when you order the COVID vaccine the state sends all the setup materials such as syringes and needles. Although I don’t always love the needles they send, I do love the syringes they use because we don’t lose a drop of the vaccine.

At our clinic, we have been looking at our schedules, rescheduling nonurgent visits, and adding on extra clinics so that we can get the children in and out in a timely basis. Not delaying the vaccine is really going to help children and the community.

I think it’s important to keep the emphasis on children and the community. The misinformation that children don’t get that sick from COVID-19 has not been borne out as the Delta variant has become dominant. Part of the preparation for the vaccine has been talking to parents about why we believe that it’s so important to vaccinate their children.

Question: How can parents prepare themselves and their children for receiving the vaccine? Do you have any tricks for distracting children during the vaccination?

Dr Koslap-Petraco: I think it’s really important to prepare children for the vaccine. I think parents need to be honest with their children. I don’t like the word needle, I prefer to use the word pinch. I tell the child I’m going to pinch them and I tell them it’s going to be over really quickly. Other people have used the word poke, instead of needle; I don’t like poke as much as I like pinch, but either one is perfectly acceptable.

I’m a firm believer that parents should be able to hold their children while they are being vaccinated. I also am a firm believer in using distraction techniques such as bubbles. I have the parent blowing bubbles and with the child’s hands down in front holding onto the bubbles, allow the child to blow bubbles while we do the actual pinch.

Another distraction technique we use is having the child take a deep breath in and then blow out really quickly while we give the pinch. I’m always looking for ways to distract children that do not require gadgets and that are inexpensive. But the bottom line is that it is really about just talking to the children through the vaccines.

Question: Do you recommend that children receive both the COVID-19 and influenza vaccines at the same time?

Dr Koslap-Petraco: Yes, I do recommend that children come in for both the flu shot and the COVID-19 vaccine at the same time. It is much easier on the parents. By getting both shots at the same time, the parents don’t need to remember to make an appointment and come in for the other vaccine.

We’ve been preparing parents for this all along. We are expecting a double whammy [of flu and COVID-19] this winter because the children are back in school, in classes together, and playing outside together. I encourage outdoor play where children don’t have to be masked and can enjoy each other’s company. I would rather see the parent give the extra time to let the children play outdoors and get the 2 vaccines done at the same time, rather than maybe cutting down on some playtime for the children because they have to make 2 trips.

When giving multiple shots, I like to give the COVID-19 vaccine in one limb and the flu shot in the opposite limb because the COVID vaccine can cause a sore arm or a sore leg, which is perfectly normal and goes away quickly. The CDC is recommending that clinicians give children all the vaccines that they are due at the time of their appointment. In addition to the COVID-19 vaccine, clinicians can give the MMR and Tdap boosters; any additional shots should be separated by at least an inch from the other shots.

In the clinic, we’re offering the children comfort measures such as cold compresses. With the COVID-19 vaccine, I advise parents to give children an ice cube wrapped in a washcloth or cold water on a washcloth and place that on the arm or leg that got pinched to reduce any residual pain or soreness.

Question: For parents who may be hesitant or anxious about the COVID-19 vaccine use in children, how do you counsel them about safety and efficacy of the vaccine and what side effects to expect?

Dr Koslap-Petraco: I have parents on both sides of the vaccine fence. Those who are banging the door down and are looking for appointments to vaccinate their children already. And then I have other parents who are hesitant. Both are perfectly fine. My job is to reassure them. My job is to tell them about how many thousands and thousands of doses we’d given to adolescents already and that the vaccines have a very good safety profile.

I know parents are worried about the risk of myocarditis. I tell them that currently what we see is that it is a rare side effect of the COVID-19 vaccine in children and most commonly occurs in older adolescent boys. I tell them if their child does get this rare complication, the symptoms are not the same as in children who have full-blown non-COVID-related myocarditis. If a child receives the COVID vaccine and does wind up in the hospital with myocarditis, they are released and recover very quickly. The take-home message that I tell my patients is that their child has a far greater chance of developing myocarditis if they get COVID than if we give them the vaccine and that the vaccine side effects are self-limiting.

Question: When do you anticipate having everybody in your practice vaccinated?

Dr Koslap-Petraco: Ideally, I would like to have all my patients vaccinated against the flu and COVID-19 by the end of December. The peak of the flu season in the United States starts around the end of January or into February. So the sooner we can get all the children vaccinated, the better.

We have never seen a flu season where we have both COVID and influenza to deal with. Last season, most children were not in school and people were wearing face masks. We saw an abnormally low number of influenza cases. This season, we are already starting to see some influenza activity already in November.

We as providers need to be testing to see whether a child has influenza or they have COVID. With influenza, we can give high-risk children antivirals. When it is COVID, we’re talking about isolation and quarantine. The bottom line is that COVID-19 spreads like wildfire. So we want to make sure we do as much to keep the children and adults away from anybody who does have COVID to decrease the spread.