What to do for children, what to vaccinate them with and which vaccines, if any, to give them.
Ultimately, this is your choice as a parent and you will need to consider your family's individual circumstances and weigh them against the risks, not only of covid infection in your children but also of potential transmission of the virus to the extended family and the risks we know that another extended period of home learning can have on their educational, social and emotional development.

The vast majority of children with covid 19 are asymptomatic or have mild/moderate symptoms and recover within one to two weeks. Serious adverse effects of covid infection in this age group are rare.  Estimating these risks is somewhat complicated because with each new variant, the risks and therefore the data change. For example, data in adults suggest that Omicron may cause less severe disease, but we do not yet have data to confirm whether this is also true for children. Doctors are also likely to be more cautious when treating younger patients, so the data on hospitalizations may not reflect the severity of illness in children.


Serious risks include:
1. Death: This is extremely rare, with estimates ranging from 0.03 to 0.08% in those under 18 years of age (4). The figure for those under 12 years of age is probably even lower.

2. Respiratory distress: In a study of 7,500 children at the start of the pandemic, 2% had severe pneumonia requiring oxygen and 0.7% had severe illness requiring intensive care. 22% of these children had underlying medical conditions, with asthma or other chronic lung disease being the most common. 

3. Multisystemic inflammatory syndrome in children (MIS-C): It is characterized by inflammation of the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs in children after covid infection and can lead to multi-organ failure. It is a rare disease, affecting less than 1% of children, and appears to be more common in black, Hispanic, and South Asian children, as well as those with a history of asthma (especially if uncontrolled) and those who are obese.  It appears to be less common in Asian children.

4. Myocarditis: This is an inflammation of the heart muscle, which can present in a variety of forms, from mild/asymptomatic to severe chest pain, shock, heart rhythm abnormality and sudden death. The most common cause in children is a viral infection, of which covid infection is one.  Before covid 19, it was very rare, with an estimated rate of 1-2 per 100,000 children aged 6-7 years. During the covid period, we have seen this rate increase by about 30% (8). Although the absolute number of children with myocarditis after covid infection remains small, the risk attributable to covid is significant.

5. Neurological problems: These are actually quite common in children hospitalized for covid. Hospitalization for serious illness in children, as we have said, is low, so the absolute number of children with neurological symptoms is even lower, and in the majority of cases, these symptoms will be transient.  However, in one series 9, 2.5% of hospitalized children had the severe neurological disease, including seizures, stroke, psychosis, and brain swelling. 1% of these children still had neurologic deficits at discharge.

6. Prolonged Covid: The number of children with persistent symptoms after covid (fatigue, headaches, sleep disturbances, muscle and joint pain, breathing problems, palpitations, and altered sense of smell or taste) varied widely in the reports, ranging from 4% to 66%.  It is difficult to be sure that these symptoms are due to covid infection and not to the effects of the pandemic; in three studies that included a control group, there was no difference in the number of children with these symptoms whether or not they had prior covid infection. Nevertheless, covid is likely to cause persistent symptoms in some children.

What is happening around the world for vaccinations in this age group?

- The UK is currently only vaccinating 5-11-year-olds if they have underlying medical conditions. Here is a link to the green bookhttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1045852/Greenbook-chapter-14a-11Jan22.pdf  which lists these conditions. However, this is likely to be extended to include all 5-11-year-olds in the near future.
- The USA, Australia, France and Canada are already offering the vaccine to all 5-11-year-olds.