Parental uncertainty about COVID-19 vaccination for children aged 6 months to 4 years has persisted since the vaccine’s approval in this age group.

“Children aged 6 months to 4 years were initially expected to become eligible for COVID-19 vaccination following the February 2022 ACIP meeting,” Aaron Scherer, PhD, said. “Prior to this meeting, there were only two peer-reviewed publications on parental COVID-19 vaccination intentions for children in this age group, which used survey data collected in February and March 2021—almost an entire year earlier. Given the dynamic nature of the pandemic, it was unclear how parents felt about having their child in this age group vaccinated against COVID-19 now that their child becoming eligible for vaccination appeared imminent.”

Dr. Scherer noted that there was a “last-minute decision” to postpone discussion of COVID-19 vaccination for children aged 6 months to 4 years due to concerns about increased myocarditis/pericarditis risk after pediatric COVID-19 vaccination; the vaccine was approved for this age group in June 2022.

For a study published in JAMA Network Open, Dr. Scherer and colleagues examined parental intentions regarding COVID-19 vaccination for children aged 6 months to 4 years. An online survey was distributed to US parents with children in this age group “to assess COVID-19 vaccination intentions,” Dr. Scherer said. He noted that the survey was conducted “just weeks prior to the ACIP meeting where discussions about whether to make children aged 6 months to 4 years eligible were expected to occur.”

Take ‘Every Opportunity’ to Recommend Vaccination

The final sample included 2,031 respondents, for a participation rate of 73.5%. More than half of the sample had personally received at least one dose of a COVID-19 vaccine (weighted percentage, 59.8%).

While approximately half of respondents (weighted percentage, 45.6%) stated that they “definitely” or “probably” would vaccinate their child once they became eligible, only about a fifth (weighted percentage, 19.0%) reported that they would get a COVID-19 vaccine for their child within 3 months of eligibility (Figure).

“I think one of the most important finding from our study is that most parents feel most comfortable with their child getting a COVID-19 vaccine where their child regularly receives healthcare,” Dr. Scherer noted. “As a result, physicians should take advantage of every opportunity and strongly recommend COVID-19 vaccination for their pediatric patients when they are in for a visit.”

Among parents who did not definitely plan to have their children vaccinated, the most common concerns related to vaccine safety, and more vaccine safety information for this group was the most selected option for increasing confidence in vaccinating their child, Dr. Scherer explained. “Concerns about vaccine safety have been the predominant reason for COVID-19 vaccine hesitancy across age groups, and it was still prevalent over a year after the vaccines first became available to the public.”

Findings Align With Real-World Concerns

Dr. Scherer pointed out that the findings related to concerns about vaccine safety “appear to track” with the real-world concerns of parents since the vaccine was approved for this age group.

“Even more troubling is the persistence of these concerns, indicating that efforts to promote confidence in COVID-19 vaccines have been unsuccessful,” he said.

Dr. Scherer offered several suggestions for clinicians. “Like many healthcare providers have probably already experienced, pediatric COVID-19 vaccine hesitancy is unlikely to be a problem that information alone can fix,” he said. “The saying ‘Nobody cares how much you know, until they know how much you care’ is especially relevant when it comes to discussing vaccines. Instead of immediately responding with all the reasons you think a parent shouldn’t be concerned about vaccinating their child, empathically ask what specific concerns they have, thank them for sharing their concerns with you, and then ask if it would be OK if you shared your perspective.”

Future research could employ information from “a growing body of research” that shows “there are general psychological traits/needs (eg, moral purity; needle sensitivity; general conspiracy mindset) that contribute to vaccine hesitancy,” Dr. Scherer continued. “Vaccine hesitancy might be an expression of a person’s general psychological traits or needs, which might explain why interventions that exclusively focus on addressing concerns about vaccines have had limited success. We might have more success at increasing vaccine confidence and uptake if we develop interventions that target the underlying psychological processes that contribute to vaccine hesitancy.”