Do children who’ve already had COVID-19 really need a vaccine?

COVID-19 vaccines are expected to win final federal approval within days for children ages 5 to 11, and while scientists and doctors say it is the best way to protect against the virus, many parents are conflicted about whether to vaccinate their young children — even if the adults got the vaccine themselves.

Nearly a third of parents said they would not get their 5-11-year-old vaccinated, while another third said they would wait to see how the vaccine is working before deciding, according to an October survey by the Kaiser Family Foundation. A slightly smaller group — 27% — said they planned to get their child vaccinated as soon as shots are approved for the younger age group.

Potential immediate side effects, fear of unknown long-term effects, and not enough time to get more robust data were among parents’ top concerns about the vaccine for their young children, the Kaiser poll found.

Deciding whether to vaccinate your child is a personal decision, but one that also can impact others. Here are some questions parents are asking, and experts’ answers.

Antibody blood tests can determine if a person was previously exposed to COVID-19, since the presence of antibodies indicates the body fought off the virus. This can be helpful in determining whether someone who did not have symptoms was exposed. But since children should get the COVID-19 vaccine regardless of whether they had the virus, getting tested for antibodies isn’t necessary, said Raymond Cattaneo, an Einstein Health pediatrician and assistant clinical professor at Thomas Jefferson University.

COVID-19 vaccines are recommended even for adults and children who previously contracted the virus. Antibodies that develop in response to a COVID-19 infection give some level of natural immunity, but it’s unclear how well natural immunity protects against new infection and how long it lasts, Cattaneo said.

“We don’t know what to do with that ‘immunity.’ Even though it may be floating around in our body, what is it actually doing? We don’t know what level is appropriate to protect us or how long it protects us,” he said.

Vaccines have been subjected to far more scientific scrutiny than natural immunity, and offer more certain protection.

Though most children have mild or even no symptoms, some can become seriously ill with COVID-19 infections.

At the FDA advisory panel hearing, scientists and officials noted that 8,300 children ages 5 to 11 had been hospitalized with COVID-19 and nearly 100 had died over the course of the pandemic.

“We don’t have a great way of predicting which children are going to do fine and which are going to develop severe cases,” said Ritu Banerjee, an associate professor of pediatric infectious disease at Vanderbilt University.

Vaccination is seen as a key way to help children remain in the classroom, and avoid the quarantining and return to virtual school that many have suffered when classmates get sick. And more young kids are getting COVID-19 in the Philadelphia region: In Montgomery County, just 6% of all COVID-19 cases have been in the 5-11 age group since the start of the pandemic, but their share of the cases shot up to 14% of all cases in September and October this year.

The vaccine approval system is set up to evaluate individual risk of getting sick against any risk associated with a vaccine, said Jessica Calcaro, an associate professor of sociology at Indiana University, who has studied how families are responding to the pandemic. And the benefits of vaccinating children go beyond their individual health. For instance, unvaccinated children can pass the virus to vulnerable family members.

“That’s where the individual risk-benefit calculation breaks down,” Calcaro said. “When parents don’t perceive an individual benefit, it becomes easier to focus on the risks.”

The two-dose Pfizer COVID-19 vaccine is approved for children 12 and older. The Moderna and Johnson & Johnson vaccines are only approved for adults age 18 and older. The FDA has authorized the Pfizer vaccine for children ages 5 through 11, at a lower dose than older kids and adults get. In the first days of November the CDC will make specific recommendations on who should get the shots — the final step before providers can begin administering the shots.

» READ MORE: Kids 5-11 will soon be able to get the COVID-19 vaccine. Here’s what you need to know.

The most common side effects are injection-site pain and redness, headache, fever, chills, and tiredness — the same side effects adults experience. In extremely rare cases, adolescents have developed myocarditis, a heart inflammation that also is a side effect of an actual COVID-19 infection.

Myocarditis is an inflammation of the heart, usually caused by a virus. Symptoms include chest pain, and difficulty breathing. An Israeli study published this month found that among 2.5 million vaccinated people aged 16 or older, 54 people experienced myocarditis after receiving the vaccine — a rate of 2.13 cases per 100,000 people. Nearly all cases were mild or moderate and did not require hospitalization, with the greatest prevalence among men and boys aged 16 to 29.

Pfizer’s studies among 5-to-11-year-olds and 12-to-18-year-olds did not identify any cases of myocarditis — the complication is so rare it was only identified after millions of people had been vaccinated. FDA advisers have said the benefits of the vaccine outweigh the rare risk of myocarditis for children.

» READ MORE: An illustrated guide to how the COVID-19 vaccines work

There is limited data on the vaccines’ long-term effects on children, simply because not that much time has passed since trials involving children began. But older adults who have been vaccinated longer haven’t experienced notable long-term effects. Consider, too, that there is evidence that “long COVID,” as long-term effects of the viral infection itself has been dubbed, can lead to complications, such as fatigue, headaches, and shortness of breath that last for months after infection, even among children, and even among patients who never had to be hospitalized.

“It’s a risk-benefit discussion. We know the long term impacts of having natural COVID infection are significant. I’d rather have the side effects of a vaccine [such as muscle pain, fever, tiredness] than long COVID,” said Banerjee.

» READ MORE: Millions have lost a loved one to COVID-19. Grief’s mental and physical burden is especially heavy on kids.