Covid-19 vaccination for kids in S'pore aged five to 11: How parents can prepare their children

Parents of younger children will soon be able to make bookings for them to get their Covid-19 vaccine, now that the Pfizer-BioNTech/Comirnaty vaccine has been approved for children aged five to 11.

From the end of this month, children from Primary 3 to 5 will be able to get their first jabs, with younger ones following suit early next year.

The vaccination exercise will involve more than 300,000 children. Paediatricians offer suggestions on how to prepare children for the vaccine.

Q: Should I talk to my child about the vaccination?

A: Dr Elizabeth Tham, consultant and head of the division of paediatric allergy, immunology and rheumatology at National University Hospital's Khoo Teck Puat - National University Children's Medical Institute, said: "Children aged five and above are old enough to understand what is happening to their body and around them.

"It is thus very important to help them prepare for vaccination at least a few days in advance, if their parents choose to proceed with it."

Giving children time to prepare and ask questions will help them feel less confused, anxious and upset during the unfamiliar process, so that it will be a smoother and less distressing experience for them and the family, said Dr Tham.

"As there are two vaccine doses, a highly unpleasant or unexpected experience at the first dose may make it more difficult for the child to complete his or her second dose."

Dr Darryl Lim, a consultant paediatrician at Kinder Clinic in Mount Alvernia Hospital, said: "Find out what their fears and thoughts are on the whole process... and whether they might have had prior negative experiences in the hospital.

"Most primary-school kids will understand why they're getting the vaccine, which is to protect them... to help their body fight off the virus and to keep them safe, so they don't fall very sick."

He added: "Give some time to the discussion, and it shouldn't be when you're in a flustered state or when you're on the way to an event."

Parents can also walk their child through the entire procedure, from the vaccination to the observation period so they know what to expect.

It might be helpful to also watch videos or read a book on getting injections, or role-play using doctor's kits, he said.

Use child-friendly language, like "you're going to feel a pinch or a poke", he said, and avoid words with negative connotations.

"For instance, you might not want to use phrases like 'you're going to get a shot', because to some kids, 'shot' is like gunshot."

Q: What about children who are afraid of needles?

A: Dr Cheng Tai Kin, who runs Kinder Clinic at Parkway East Hospital, said most children are reluctant to get injections and are scared of the pain.

"Some children will cry and may need an adult to be with them and comfort them," he added.

Dr Lim suggests taking along some ice packs or a cool water bottle to numb the injection site.

"You can tell them that it's going to be a smaller needle, and if they're very fearful, maybe they don't want to look at the needle and they can close their eyes."

Parents can also let their children watch a video during the jab to distract them or take along books to read during the waiting time after.

Dr Tham suggested telling children that they had already gone through a similar process during their childhood immunisations, even if they do not remember it.

Parents can share their own vaccination experience with the child - how their own body responded and how they managed the symptoms, to show them it is something that many people have gone through and that it is safe, she said.

She added that children should continue their daily routine on the vaccination day, have a good meal and be well-hydrated before the jab, to avoid dizziness or fainting.

"They may also choose to take along a small comfort object to the vaccination centre and to reward the child with a small treat after the vaccination to help them feel more comforted," she said.

Q: What are the side effects?

A: Dr Cheng said parents should treat the vaccine as "any other childhood immunisation. There's nothing extraordinary about the injection itself. It probably will be less painful than other vaccinations, if the volume given is similar to the adult Covid-19 vaccine." 

Dr Tham said parents may choose to have their child vaccinated earlier in the day, and schedule it so that they can look out for symptoms over the next two to three days.

Immediate allergic reactions like anaphylaxis can usually be detected during the 30-minute observation period at the centre, she added.

This presents as a combination of rashes, swelling of eyes or face, breathing difficulties, low blood pressure or severe abdominal pain.

Parents should monitor the child for the next 24 to 48 hours for delayed symptoms, like fever, muscle aches or lymph node swelling - similar to what adults experience.

These side effects are similar to those for children's vaccines like the three-in-one vaccination against diphtheria, tetanus and pertussis that Primary 5 pupils undergo yearly.

Dr Tham said: "Normal daily activities can be continued, but children should avoid vigorous activities like physical fitness lessons, sports enrichment classes for at least two weeks after each vaccine dose."

Worrisome symptoms which warrant a doctor's consultation, she added, include persistent chest pain, breathlessness or persistent fever that lasts beyond three days.

"Myopericarditis is very rare - around three per 100,000 doses in individuals aged 30 years and below - and its symptoms include persistent chest pain, palpitations or an irregular heartbeat," she said.

Q: Why do children need to be vaccinated against Covid-19 when the majority of them get a mild form of the disease?

A: Experts said this is to ward off serious illness in the case of future surges of the virus.

Dr Cheng Tai Kin, who runs Kinder Clinic at Parkway East Hospital, said: "With the Omicron variant and waves in infections, the fear is that the base number of cases grows by a lot.

"Then you will have more children infected and, as a result, a corresponding higher number of them getting severe forms of Covid-19."

This means they would need hospitalisation, oxygen supplementation and possibly intensive care.

Dr Cheng noted that when the number of community cases in Singapore was low, not many children were infected. But as the figure grew in recent months, so did the number of children getting Covid-19.

Vaccination has not been rolled out for children under the age of 12, who accounted for 11.2 per cent of all cases on Nov 19.

In comparison, the figure was only 6.7 per cent of all cases four weeks ago in October.

There have also been one or two cases of multi-system inflammatory syndrome in children (MIS-C) every week in Singapore since mid-October, with some cases requiring care in the intensive care unit.

MIS-C, which affects a small minority of children afflicted with Covid-19, is a condition where different body parts, including the heart, lungs, kidney, brain and eyes, can become inflamed.

Dr Tham said the late effects, like "long Covid", in children are still unknown.

This refers to lingering symptoms like fatigue and chest pains weeks and months after infection.

"High-risk children with pre-existing medical conditions that put them at higher risk of severe Covid-19 would also benefit from early vaccination," she said.

"Vaccination also reduces the extent of transmission to adults, elderly or vulnerable people around them who may be medically ineligible for vaccination."

Senior Minister of State for Health Janil Puthucheary said last week that vaccination will keep children from becoming severely ill and reduce the risk of severe complications such as MIS-C.

A study of the Pfizer vaccine conducted in the United States showed that it is 90.7 per cent effective in preventing symptomatic forms of Covid-19 in children aged five to 11.

In response to parents' concerns about the safety of the vaccine, Dr Janil cited results from a study of the Pfizer vaccine conducted in the United States that show the risks of adverse reactions are low.

In fact, children aged five to 11 had fewer side effects compared with those aged between 16 and 25.

The US Centres for Disease Control and Prevention (CDC) said last Thursday it had received reports of eight cases of myocarditis in children aged five to 11 who received the vaccine.

There had been over seven million vaccine doses given in this age group at the time that the data was examined, with 5.1 million first doses and two million second doses.

Dr Cheng said the data is too preliminary and needs to be analysed further. "It's too early to conclude. We need to look at the baseline rate of myocarditis in this age group of children without vaccination.

"Eight cases from seven million doses is roughly one in a million. That's 50 times lower than the 40 to 69 cases per million doses in male teenagers that was previously reported."

According to the CDC, the reporting rates of myocarditis for boys aged 16 to 17 were about 69 cases per million second doses administered and around 40 cases per million second doses in boys aged 12 to 15.

Given that more than seven million children in the US, Israel and Europe that have received at least their first dose of the vaccine, Dr Tham said, "the real-world safety data from their experience should be available very soon.

"There have thus far been no reports that children in this age group experience higher adverse event rates than adolescents and adults."

Other countries such as Canada, Israel and Australia have also given the green light for the use of the Pfizer vaccine for children aged between five and 11.