Five years later, we reflect on all that has occurred and changed since March 4, 2020. We asked Cook Children’s employees to reflect on their experiences during the COVID-19 lockdown and how they experienced growth, loss, and change.

As COVID-19 cases rise at Cook Children's, the Food and Drug Administration has approved an updated COVID vaccine.

The Centers for Disease Control and Prevention recommends that anyone 6 months and older should get the new shot to protect against serious illness.

COVID cases at Cook Children’s Medical Center have been steadily increasing since early July. From the week of Sept. 17 through Sept. 23, the positivity rate is 10% or 69 positive cases out of 679 patients tested.

The new vaccines from Pfizer and Moderna are matched to protect against the most common COVID variants circulating now. Please contact your pediatrician's office to schedule an appointment.

The fall and winter months are a common time for respiratory illnesses to spread in our community; in addition to COVID-19, there is typically a rise in flu and RSV cases.

Schedule you and your child’s flu shot as soon as possible to help prevent severe illness and spread of the flu.

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. It is the leading cause of hospitalization for infants, who are much more susceptible to the disease.

This year, infants will have a better chance of protection if they receive the new monoclonal antibody injection for the prevention of severe RSV, which has been shown to reduce the risk of hospitalization and health care visits in infants. This one-time injection was recently approved by the FDA and recommended by the CDC. The treatment will be available at Cook Children's pediatrician offices soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, answers some of the top questions from parents regarding these respiratory illnesses, treatment and prevention.

COVID

What are COVID cases like right now? Why should my child get the new COVID vaccine?

Positive COVID cases at Cook Children’s Medical Center have been steadily climbing since the end of June and early July. Across the country, there are higher rates of COVID hospitalizations in both adults and pediatrics. Your child should get a yearly COVID vaccination because we know that this will protect them. People who are vaccinated against COVID have a significantly decreased risk of hospitalization, ICU admission, and death.

What are the symptoms of most COVID cases right now?

Symptoms are mainly upper respiratory symptoms (cough, nasal congestion, sore throat). It’s also causing fevers, muscle aches, and fatigue. And yes, these symptoms are very similar to the flu! 

Should my children and I be wearing face masks? 

You should consider wearing a mask if you, your child, or anyone in your home is at high risk for severe COVID-19 infection. This includes people who are 65 years and older and people with certain medical conditions such as heart conditions, lung disease, diabetes, sickle cell, or a neurologic condition.

During flu, RSV, and COVID-19 seasons, it is very reasonable to wear a mask whenever you are in crowded indoor spaces. This includes pediatric office and emergency room waiting rooms!

My child is involved in many in-person activities this fall. What can we do to protect against COVID?

• Consider wearing a mask
• Get the latest vaccine
• Stay home if you are sick

My child’s classmate tested positive for COVID. What should I do?

• If your child is having symptoms, test immediately. If the initial test is negative, repeat in 48 hours if your child is still symptomatic.
• If your child does not have symptoms, wait five days and take another test.

If my child received a COVID vaccine more than six months ago, should they get the new vaccine?

Yes, they should! The CDC recommends that anyone 6 months and older who is two months out from their last COVID vaccine get the new vaccine.

Will it protect my child against the latest variant?

Yes, the newest vaccine was designed for the currently circulating variants so it should help protect your child.

FLU

What are flu cases like now? When is flu season?

Flu cases are currently low at Cook Children’s. Flu season typically begins in the late fall and stretches into the winter. However, last year we saw unprecedented numbers of influenza very early in the season.

Why should my child get a flu shot?

 Flu vaccines help protect against severe cases of the flu. If your child gets the flu vaccine, they may still get the flu, but they will have more mild symptoms and should not need to be hospitalized with a severe infection.

When will flu shots become available?

Flu shots are currently available at many Cook Children’s pediatrician offices. Check with your pediatrician’s office. Many local pharmacies have them as well.

RSV monoclonal antibody shot

What age groups can get the RSV monoclonal antibody injection?

Infants under 8 months during their first respiratory season and children who are at high risk up to 24 months of age. Talk to your pediatrician about your child’s risk, especially if they have a history of prematurity, heart disease, or chronic lung disease.

What should parents consider with this antibody treatment?

Our babies and infants are the most vulnerable population during cold and flu season so this will give them some protection and lower the chances of having a severe infection.

RSV can cause symptoms ranging from a runny nose to respiratory failure, requiring an ICU admission. It usually causes mild, cold-like symptoms, but it can be serious, especially for infants.

RSV causes bronchiolitis, which can be very serious and sometimes fatal in babies. The new antibody treatment has been shown to reduce the risk of hospitalization by nearly 80%, according to the CDC.

When will the new antibody be available?

The new antibody treatment will be available soon. For newborns, it may be given in the nursery prior to your infants discharge after birth. For older infants, families should reach out to their pediatrician about availability.

Will my child show symptoms once they receive the antibody shot?

Your child may still get symptoms of RSV after receiving the treatment but they are expected to be less severe.

Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long is it effective?

Since this is an antibody and not a vaccine, it is designed to provide a temporary boost in immunity only. It will provide short-term protection lasting about 5 months which should cover the 2023-2024 RSV season.

If my child previously had RSV, do they have antibodies?

Yes, but the antibodies your body’s immune system makes to RSV last only two to three months. It is very possible for a child to get RSV multiple times in one respiratory season.

Related stories:

• Fighting RSV: Physicians Say New Antibody Shot Could be Game Changer 
• CDC Recommends RSV Shot for Infants. Infectious Disease Doctor Shares What Parents Need to Know 
• Curious About Health and Safety Requirements at Day Care? We Have Answers
  
   

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, recently got her her almost 4-year-old daughter and 20-month-old son vaccinated. She shared advice for how to prepare your young child.

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible. The COVID positivity rate has slowly climbed at Cook Children's Health Care System. On July 19, the daily positivity rate was 30.6%.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

Dr. Romano's Tips on How to Prep Your Children for Shots:

1.     Be upfront about what’s going to happen!

• I always tell my children a few days early that they will have a doctor or a dentist appointment!
• I tell them what’s going to happen at each visit. For example, “Jay, you’re going to go see your pediatrician. They’re going to listen to your heart and your tummy!”
• If they’re going to get shots, let them know that as well. “Danielle, we’re going to go see your doctor. You will need two shots at the visit.”

2.     Talk about the immunizations and let them ask questions.

• We talked a lot about the COVID vaccine before my children were even eligible.
• We talked about why it was important in an age-appropriate language.
  • My son, who is 20 months, was told that it was to keep him healthy and strong!
  • My daughter, who just turned 4, knows it’s to protect against a virus called COVID. COVID can make some people very sick so it’s really important that we do everything we can to protect ourselves and others from germs.
• Let them know that it might pinch or hurt for a few minutes but it’ll be all done soon!

3.     If they want, let them play doctor and practice giving a shot.

• My daughter loves to play doctor so our stuffed animals and sometimes our younger brother receives a lot of “check-ups” and sometimes “shots.”

4.     Let them bring a distraction or a friend to make them feel brave at the actual appointment itself.

• We brought my daughter’s favorite stuffed animal best friend, Bear Bear, because he made my daughter feel safe.
• We also had a few songs loaded on our phones in case they needed some extra help.

5.     Let them choose where they want to get the shot and also how they want to get it.

• Do they want Mommy or Daddy to hold them? Do they want to lay down by themselves?

6.     After it’s over, give them lots of hugs and love!

• Sometimes a little bribery goes a long way! Bribery can be in the form of a lollipop, a piece of candy, a new toy, or just a fun new sticker!

7.     After any vaccine, a child might run a low-grade fever (less than 100.5 F) and might have some muscle aches, so please feel free to give them Tylenol and Motrin. This will not blunt an immune response to the vaccine! 

RELATED: COVID-19 Cases Increase at Cook Children’s (checkupnewsroom.com)

Distribution of the Pfizer-BioNTech and Moderna COVID vaccines for the youngest age group will begin this week. The CDC's Advisory Committee on Immunization Practices’ (ACIP) recommended that all children 6 months through 5 years of age should receive a COVID-19 vaccine.

This expands eligibility for vaccination to nearly 20 million additional children and means that all children ages 6 months and older are now eligible for vaccination, the CDC said.  

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

The rolling seven-day average positivity rate:

• June 20: 10.6%
• June 5: 8.4%
• May 5: 3.5%

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

The vaccines are being distributed and will be available at thousands of pediatric practices, pharmacies, Federally Qualified Health Centers, local health departments, clinics and other locations, the CDC said.

Cook Children’s is currently working on its plan to distribute vaccines to pediatrician offices and will announce details regarding scheduling soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, has two children, an almost 4-year-old daughter and a 20-month-old son.

“My son was exposed and tested positive when he was 10 months old. We were very fortunate because I had received my COVID vaccine when he was 8 weeks old so he had plenty of antibodies and protection from me and my immune system,” Dr. Romano said. “We escaped his illness with two days of congestion and one day of fussiness. I, unfortunately, know that not all families have been as lucky.”

“These are some of our most vulnerable patients, and being able to provide them protection against COVID will be a huge relief to so many parents, including me!” Dr. Romano said. Here are her answers to some frequently asked questions:

Why should my child get the COVID vaccine?

It is extremely important to get everyone who is eligible vaccinated.

Vaccinating against COVID is what will continue to allow everyone to return to a more normal life. 

People who are fully vaccinated are significantly less likely to spread COVID-19 because of their smaller viral load, which means a lower risk of transmission to others. That’s one of the main reasons why I’m so excited to get my children vaccinated against COVID. My father is a type-1 diabetic with rheumatoid arthritis who is immunocompromised due to his medications, and I always worry about accidentally spreading COVID to him.

Additionally, someone who is vaccinated against COVID, even if they are exposed and test positive for COVID, is at a significantly decreased risk for complications such as ICU admissions, the need for life support and death.

Here at Cook Children’s between Dec. 19, 2021 and Jan. 15, 2022, there were more than 14,800 children who tested positive for COVID at their pediatrician’s office, a Cook Children’s Urgent Care, or at the medical center. Out of 321 patients who required hospitalization, only 18 were vaccinated against COVID. Out of the 37 patients admitted to the PICU with COVID, only two were fully vaccinated. This data strongly suggests that the vaccine is effective at preventing hospitalizations and at preventing ICU admissions.

COVID vaccines also help prevent MIS-C, multisystem inflammatory syndrome in children. MIS-C is a potentially very serious complication that we see four to six weeks after a COVID infection or exposure. Out of a large cohort of 21 million vaccinated young adults, only 21 children developed MIS-C after COVID vaccination. This tells us that not only can a COVID vaccine prevent severe illness from an acute infection, but it can also prevent some of the more serious complications following COVID exposure.

COVID vaccinations also prevent long-haul symptoms such as daily headaches and persistent fatigue. Although not common, we do see COVID long-haul symptoms in a pediatric population. Patients who are fully vaccinated against COVID are 50% less likely to develop long-haul symptoms.

COVID vaccines do not affect a woman’s fertility. The American College of OB/GYN, the Society of Reproductive Endocrinology, and the Society for Maternal Fetal Medicine have recommended COVID vaccination for all women whether they are pregnant, or trying to become pregnant, or breastfeeding.

On a more practical aspect, a fully vaccinated person will also have different quarantine requirements after exposure or testing positive for COVID. As someone who lived through a 10-day quarantine, I would not recommend or want to repeat it. A fully vaccinated person can have shorter quarantine periods.

How do we know it’s safe for children 5 and under? 

Despite the name “Operation Warp Speed,” the process to investigate and certify the vaccine did not cut any corners. Throughout the vaccine development process, researchers had to follow the same procedures and regulations as if they were developing a new medicine for headaches or blood pressure.

In addition, both the Pfizer and Moderna studies have increased their sample sizes throughout the process to make sure that side effects or reactions are not being missed. Participants in the study were closely monitored.

Should parents get their children vaccinated, even if their child recently had COVID?

Children should be vaccinated even if they already had COVID. Some studies have suggested a second or a third infection can be associated with more severe disease. More severe disease could mean hospitalization, ICU admission and even death.

Some infectious disease experts recommend waiting three months after COVID infection before being vaccinated so that the vaccine has the maximum effect.

Why should my child be vaccinated if they have already had COVID?

I hear a lot of parents, neighbors and friends say that they tested positive for COVID and only had mild flu-like symptoms. However, this is not always the case. While I’m happy that your first case was mild, please know that your second infection may not be the same.

What if I live in an area with a low number of cases? 

If you live in an area with a low number of cases, please still get your vaccine. With the global nature of our world, you will have plenty of opportunities to come into contact with people who come from areas with high number of cases.

COVID vaccines can also be extremely important if you want to travel. Some countries or cruises require you and your child to be fully vaccinated before travel.

Do I have to vaccinate my baby on schedule if I am breastfeeding him/her?

After a breastfeeding mother is vaccinated against COVID-19, antibodies pass through her breast milk to her baby. Various studies have found that the 87 – 95% of babies were given immunity through their mother’s breast milk against COVID-19. If it’s been more than six months since the mother received her COVID vaccine or booster, she should consider vaccinating her baby at this time.

How soon after the vaccine will my child build immunity?

Immunity will begin after the first shot! Immunity and protection have been demonstrated in Pfizer recipients within 12 – 14 days after the first dose, but this will be very short-lived. Immunity will be more permanent two weeks after the second dose.

Are the side effects of the vaccine different for children?

The main side effects are very similar to adults. There will most likely be injection site tenderness and some muscle aches. There can be redness and swelling along the injection site. Most people report fatigue and malaise that should be resolved within 48 hours.

A very concerning side effect that we saw in young men was myocarditis. However, only saw four cases in every 1 million vaccines in children 5 – 11 years old.

How do I know if my child is eligible for the vaccine?

Children over 6 months old are now eligible for the vaccine!

There are only a few very strict contraindications to receiving the COVID vaccine. The two absolute contraindications are having a severe allergic or anaphylactic reaction to a prior COVID vaccine or a known allergy to a component in the COVID vaccine.

If you have any questions about children with known clotting disorders, heart problems, or prior neurologic processes such as Guillain-Barre Syndrome, please talk to your primary care provider. The CDC recommends that these patients can receive a COVID vaccine with proper precautions.

RELATED: 

How to Help Young Children Cope with Vaccine Anxiety (checkupnewsroom.com)

7 Reasons Why This Doctor Mom’s Kids Will Be First in Line for the COVID Vaccine (checkupnewsroom.com)

Vaccines are the best way to prevent serious illness in people of all ages, including children. Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated and booster shots as soon as they are eligible. Children ages 5 to 11 will now be eligible for the extra dose at least five months after their second shot.

This news comes after the first booster (third dose) of the Pfizer-BioNTech vaccine was approved for children ages 12 to 17.

We asked Nicholas Rister, M.D., of the Cook Children's Infectious Disease team to answer some of the top questions that parents and caregivers might have.

Why should my child get the COVID vaccine booster? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly, but vaccination can prevent more severe disease from developing. This is especially true for children with underlying risk factors including obesity, chronic lung disease including asthma, seizure disorders, and immunodeficiency.

How do we know it’s safe for children 5 to 11?  

A pediatric drug trial involving 140 children aged 5 – 11 years was submitted to the FDA showing high efficacy and safety.  Additionally, blood samples showed similar antibody development compared to data in older children and young adults. A large increase in antibodies that specifically target COVID-19 were observed in patients after a third dose of the vaccine, regardless of whether they had previously had COVID disease.

How long until the booster will be available for children 5 to 11?

With formal FDA approval, all children ages 5 to 11 can be offered a Pfizer vaccine. However, be sure to check with your vaccination site if they currently have the Pfizer vaccine available for these children.

If my child recently had COVID, how long should we wait to get the booster vaccine?  

There has been little in the way of formal recommendations regarding when to get booster vaccination following COVID infection. This is largely because there is tremendous variability in different individual’s infection and how robust their antibody response is. It is generally thought that after COVID infection, there is a period of 3 to 6 months during which repeat infection, especially severe infection, is unlikely. However, there is no reason that you or your child needs to wait to get the booster. Whether a booster is given immediately after recovering from the illness or a few months later, the antibody response has been excellent.

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision.

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children. 

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

“It is important to keep our children safe now and in the future," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. "This is one way to safely protect your children AND protect people who they might expose from catching SARS-CoV-2."

We asked Dr. Whitworth to answer some of the big questions and shed a little light on the subject.

Why should my child get the COVID vaccine? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly. But while they are contagious they can spread this to others such as vulnerable grandparents.

How do we know it’s safe for children 5 and under?  

The children who participated in the vaccine research had no serious adverse events and we know that the FDA is extremely cautious and will review the data quite carefully before approving this.

Should parents get their children vaccinated, even if their child recently had COVID?  

Yes. Those who have been infected with this virus can get infected again. This second infection may be the same, milder, or more severe – and they are able to transmit SARS-CoV-2 to those who are more vulnerable.

What about if I live in an area with a low number of cases?  

SARS-CoV-2 will not be eradicated.  We will have this infection with us for years to come, just like influenza.  Low numbers now are something to enjoy, but we will all be exposed at some point in the future. 

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision. 

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

RELATED: BioNTech Asks the Food and Drug Administration to Authorize COVID-19 Vaccine for Children Under 5

Pfizer-BioNTech recently released information regarding their COVID-19 vaccine being safe and effective for children 12 to 15. The vaccine is currently available for use in those 16 and older based on previous trials and is approved for emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA). Pfizer is expected to apply for an EUA for this younger age group in the next few weeks.

We know many parents have questions ranging from how safe the vaccine is for your child down to when it will be available. Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s Medical Center, and Nicholas Rister, M.D., a pediatric infectious diseases specialist agree it’s safe to get children vaccinated once it’s approved.

With this COVID-19 vaccine being available for children 16-18 in Texas, do you recommend them getting the vaccine?

Yes. Older children are more at risk and they are very social and aren’t always the best at social distancing. They are better at spreading the virus than younger children.

Should younger children get the vaccine when it’s available?

Yes. We thoroughly encourage vaccination when all the data is available and the FDA issues emergency use.

Should children still be wearing masks?

Yes, the downside to wearing masks is minimal and the upside could be lifesaving.

Is there anything still mysterious about the virus?

We don’t fully know the long-term effects of having the COVID-19 virus. We will be monitoring it for decades to come. Getting vaccinated is the best way to go to prevent contracting the virus.

Is there a possibility families can travel with their children this summer?

We aren’t quite out of the pandemic and you have to think about the risks. Make sure it’s worth going through the precautions and see if the risks are worth it for your family.

Are children good to go back to school in person once they’re vaccinated? Children have been going back to school in person, some of them for six or seven months. It's been shown that there's very little transmission in the schools when good precautions like wearing a mask and social distancing are followed. The CDC now says distancing only needs to be three feet in schools as long as everybody's wearing a mask. Children can go back to school safely, even if they're not vaccinated, but this has to be a decision families work out amongst themselves and their doctors. It depends on if your child has underlying medical problems, if your child lives with someone with underlying medical problems, or if your child is going to a school where they aren't doing social distancing and they're not masking. It’s an individualized decision, but once they're vaccinated, then it will be significantly safer at school.

When will children begin to be vaccinated?

According to the studies, teenagers should begin to be vaccinated in late summer. However, that is subject to change.

How do we know the vaccine is safe for children?Once the trials are done, the data will be reviewed by the FDA and then they will issue an emergency use authorization, just like they did for adults. The FDA will look at all the data to decide if it's safe. They won't approve the vaccine if it isn't.

Will higher-risk children be among the first to receive their vaccine?

That information is not yet available.

What is the age range for children once the vaccine is available?

Pfizer is currently approved for those 16 and older. The next group to get vaccinated will be 12 and older. They are currently doing ongoing studies on children as young as six months to 11 years of age. As that information gets evaluated by the FDA, they could approve it over time, all the way down to six months of age. This will all be done in phases. Twelve to 15-year-olds could be vaccinated in the fall. A couple of months after that, maybe 6 to 11-year-olds, and they'll keep adding and going down to younger ages.

What do I do if my child is scheduled for routine shots such as Menactra, HPV, TDAP, etc.?If your child has gotten their vaccines routinely, you would wait at least 14 days to do the COVID-19 shot. If they’ve got their COVID-19 shot, you would wait at least 14 days to do any other vaccines.

What do we know about the Pfizer study?

The study is shown to be as effective in teenagers as it is in adults.

How long should the Pfizer trial take for children 6 months to 11 years old children?

Those results will not be finished, evaluated, and presented to the FDA for several months. We are looking at late 2021 early 2022, and that is also subject to change.

Will Cook Children’s be providing vaccines once they’re approved and available?

Cook Children’s does plan to provide the vaccine to pediatric patients once it is approved and becomes available. More details will be available soon.

Will children still have to wear a mask after they’ve been fully vaccinated?

Yes, for the time being, but that could change with time. It's much less likely that children can give anybody COVID-19, and it's much less likely that children can catch COVID-19 infection once they’ve been fully vaccinated. The decision about when to stop wearing masks will be recommended by the CDC and we will follow their recommendation.

Will I get to choose which vaccine my child receives?

It is important to get your child vaccinated. The vaccinations that are available work well. It is not recommended to wait for any period to get a certain brand of vaccine if a different one is readily available for your child.

Are there any medical issues that would prevent my child from getting the COVID-19 vaccine?

The only thing that would keep your child from getting the COVID-19 vaccine would be is if they’re allergic to the vaccine components or if you have an allergic reaction to the first COVID-19 vaccine.

Is there anything else I should be aware of before vaccinating my child?

On April 6, Cook Children’s shared that suicide is now the leading cause of trauma death at the medical center. In March, a record 43 patients were admitted to Cook Children’s after attempting suicide. Getting our children vaccinated is important, as vaccinations are the only way we can put an end to this pandemic and have more sense of normalcy for children.