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

Yout’s a challenging time for parents anxiously awaiting the arrival of COVID-19 vaccinations for children under the age of 5. Politico published a report on April 21 that contained insider information. They warned that vaccines may not become available until June for children under 5. 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.

However, pediatric infectious diseases specialists agree that there are many reasons parents need to feel confident, even before the vaccine is available. The risks of serious disease for children relative to adulthood are low, so parents should take extra precautions to make their child’s life easier.

How do COVID-19 and COVID-19-related risks affect children younger than 5 years old?

Even though they’re still unvaccinated, children under 5 years old face low risk of severe disease after getting COVID-19. According to data from the Centers for Disease Control and Prevention (CDC), 468 children aged 4 and below have been killed by COVID-19 since the outbreak of the pandemic. The figures were as of April 24, 2019. 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. These numbers are small in comparison to the risk for older people and patients with more serious 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.

Here are some good news 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.

Children under five are considered too young for vaccination, but that doesn’t mean their immune system is inept 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. He warns, however that this protection shouldn’t be taken as a given.

“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.”

Parents, how can you keep your children below five years old 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. Combining different risk reduction methods can provide 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. By getting immunized and being boosted, older relatives can protect children under five years of age. 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. Children have fallen behind in other vaccines that protect them from deadly diseases such as measles. “We’re holding our breath, because [measles]The pandemic caused rates to drop [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 believes that parents need to think about how they can protect their kids from COVID-19 and other infection. 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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