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COVID-19 Risks for Kids Under 5: What Parents Should Know

It’s a challenging time for parents anxiously awaiting the arrival of COVID-19 vaccinations for children under the age of 5. In a report published by Politico April 21, sources with insider knowledge warned that a vaccine may not be available for the youngest age group until late June. And after a federal judge struck down a mask mandate for public transportation on April 18—leading some plane passengers to remove their masks mid-flight—some parents expressed frustration that many people seem to forget that the littlest children still can’t be protected through vaccination.

At the same time, many pediatric infectious disease specialists say there are several reasons that parents should feel reassured, even before a vaccine arrives. First and foremost: the risks of severe disease in children are still low relative to adults, and parents can layer on precautions to keep their kids safer.

What do we know about COVID-19 risks for children under 5?

Even though they’re still unvaccinated, children under 5 years old face low risk of severe disease after getting COVID-19. Since the beginning of the pandemic, 468 children 4 and under have died from COVID-19 in the U.S. according to Centers of Disease Control and Prevention (CDC) data as of April 24. In rare but serious cases, some children have been known to develop Multisystem Inflammatory Syndrome—a potentially deadly condition in which organs like the heart, lungs and brain can become inflamed. But these numbers, relative to population size, represent a minuscule risk, especially compared to that seen among the elderly and those with underlying conditions.

Further, these small risks aren’t equal for all children. According to Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics committee on infectious disease, babies under 6 months tend to be at higher risk for respiratory illnesses, and children with preexisting conditions, such as chronic lung disease, may be more vulnerable than healthy children.

It’s too soon to tell if the latest variant causing rising cases in the U.S.—BA.2—will be especially dangerous for children under 5, says O’Leary. However, BA.2 seems to be at least 30% more transmissible than Omicron—which itself was more transmissible than previous variants that circulated in the U.S. “We are seeing cases rise, [though] they’re not rising as quickly as they did with Omicron. But it’s a little bit hard to predict where things are going to go from here,” says O’Leary.

Some good news for this spring

For all these risks, there is some “good news” about the current state of the pandemic, says O’Leary. Although cases are rising, the U.S. isn’t seeing a major surge yet, he says. It also helps, he says, that the weather is now getting warmer in the U.S.—people will have more of an opportunity to gather outside.

And while children under 5 are too young to be vaccinated, that does not mean that their immune systems are completely naive to the virus. CDC data shows that, among this age group, more and more children have evidence of antibodies created by the body in response to SARS-CoV-2—suggesting a previous infection. Although prior infections don’t offer as much protection as vaccination, or vaccination plus infection, “the more immunity there is in a community, the fewer infections overall,” says O’Leary. However, he cautions that such protection should not be taken for granted.

“We had a lot more infections with Omicron; seroprevalence has gone up for COVID—that’s not in question,” he says. “What is in question is exactly what that means, for both this BA.2 variant, and then also for future variants, in terms of protection.”

How can parents keep kids under five safe?

Even if there is no big surge over the next few months, that doesn’t mean parents should let their guard down. “We may not see rampant infection right now, but we may continue to see circulating virus in our communities for the foreseeable future,” says Dr. Ibukun Kalu, a pediatric infectious disease physician at Duke University Hospital.

Unless the entire family remains alone and inside at all times, it may be impossible to take your child’s risk down to zero. However, combining different methods to reduce risk provides layers of protection.

For one thing, says O’Leary, “outdoors is generally safer than indoors, smaller groups are generally safer than larger groups. If you’re in indoor spaces, being masked is generally safer than not being masked.”

Further, just because the youngest children can’t get vaccinated yet doesn’t mean you should forget vaccination entirely. Older family members can help to protect kids under the age of 5 by getting vaccinated and boosted themselves. Research has even found that mothers who get vaccinated while they’re pregnant can transfer some immunity to their unborn child. For babies under 6 months, says O’Leary, “the best thing you can do…is one, mom gets vaccinated during pregnancy or before, and two, everyone that’s around that baby is vaccinated.”

COVID-19 also isn’t the only disease you should be worrying about. A vaccine is available for kids over the age of 6 months for influenza—which can be deadly for young children. Many children have also fallen behind on other vaccines, which protect kids from diseases that, like measles, can be even more dangerous for children than COVID-19. “We’re holding our breath, because [measles] rates went down as a result of the pandemic [precautions],” says O’Leary. But a surge “certainly could happen as travel loosens up. There’s plenty of measles around the world right now.

Kalu says that parents should be thinking about ways to protect their children not just from COVID-19, but from other infections. Especially for little kids, that includes teaching them to wash their hands, keeping the environment clean, and keeping children home when they’re feeling sick. “Those are things that work for a stomach virus, and for COVID-19,” says Kalu.


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