What Parents Need to Know About Mixing COVID-19 Booster Shots for Children

teen girl getting a vaccine shot from a nurse

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Key Takeaways

  • Pfizer, Moderna, and Johnson & Johnson booster doses are all now approved for use in those over age 18.
  • Mixing and matching vaccine and booster doses has been approved by the FDA for those over 18, but it has not yet been recommended for children.
  • Doctors advise speaking with your primary health care provider to determine the best course for your child.

COVID-19 vaccines and boosters are rolling out almost everywhere for people over 18—and in Pfizer's case, vaccines are available for children over the age of 5, too. Despite this, there is a lot of uncertainty around how and when to get a booster dose. The science and our understanding of COVID-19 are constantly evolving, which can make it hard to keep up. Parents are especially eager to understand what to do for their kids who are old enough to be vaccinated.

All vaccines available in the United States—Pfizer, Moderna, and Johnson & Johnson—went through rigorous testing before being provided to the public, and all have proven effective at preventing severe cases of COVID-19. Though all the COVID-19 vaccines and boosters are not fully approved for children of all ages, there is plenty for parents to know, including whether or not it's safe and recommended to mix and match vaccines and boosters.

Experts share their insight on what parents should understand about mixing and matching the COVID-19 vaccine and boosters in the younger set.

Guidelines for Mixing COVID-19 Vaccines and Boosters

In September, the booster dose of Pfizer's COVID-19 vaccine was approved by the FDA. At that time, there wasn't concrete evidence to support whether or not people who initially received the Moderna or Johnson & Johnson vaccine should get the Pfizer booster. However, in October, the FDA approved both Moderna and J&J boosters, making the booster process simpler.

In the FDA's October approval of the Moderna and J&J booster doses, the organization also noted that combining vaccine brands had been studied and approved. According to the press release, "The use of each of the available COVID-19 vaccines as a heterologous (or 'mix and match') booster dose in eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine."

The Pfizer and Moderna boosters are recommended to be administered six months after the initial vaccine. The Johnson & Johnson booster is recommended to be administered two months after the initial vaccine.

Can Children and Teens Mix and Match COVID-19 Vaccines and Boosters?

The COVID-19 vaccine was approved for those under 12 on November 2, so it's still too early for that age group to consider booster shots. However, there are cases where teens may need to consider a booster. Currently, boosters are advised for people over the age of 65 or those ages 18 to 64 who are at a higher risk of being infected by the virus. If your child falls into this category, which can include those with cancer, diabetes, or Down syndrome, and has passed the required time frame, now is the time to look into another shot.

Pennsylvania-based pediatrician Jarret Patton, MD, FAAP, urges parents to err on the side of caution when it comes to mixing and matching the vaccine and booster doses. "For children who have been vaccinated, ideally, they should get the same brand as originally given in most cases," he says. "However, emerging guidance and research is now informing us that it is OK to mix brands of vaccines if necessary." 

Jarret Patton, MD, FAAP

Emerging guidance and research is now informing us that it is OK to mix brands of vaccines if necessary.

— Jarret Patton, MD, FAAP

As of now, there is no data on how mixing and matching vaccines affects children, says Christina Johns, MD, a pediatrician and senior medical advisor at PM Pediatrics. To that end, she agrees with Dr. Patton in being hesitant about children and teens mixing vaccine brands, especially this early in the research. "Parents should wait for guidance on mixing vaccine brands for their children," she says.

Both pediatricians advised parents to speak with their primary health care provider if they want to discuss vaccines and boosters for their children. This is especially important for children who are at a higher risk of contracting the virus, like those who are immunocompromised.

Though there is little data on boosters for children and teens, your health care provider can advise you on a personalized plan for your child. Dr. Patton added that until all children are eligible for the COVID-19 vaccine, he advises parents to get vaccinated to further protect their children from getting sick.

While mixing and matching vaccine and booster doses has newly been approved by the FDA, it has not yet been recommended for children. As new research is done, doctors and scientists will be able to make more clear recommendations for families.

What This Means For You

At this point in time, pediatricians are hesitant to make recommendations about children and teens getting booster shots, as they are not fully approved for all of those under the age of 18. If you have a concern about the booster shot for your own children, speak with your health care provider to decide what's right for you and your family.

As more data and research is done on the vaccines and booster shots, doctors will have a better understanding of what is safe and effective for everyone—especially children.

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3 Sources
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  2. U.S. Food and Drug Administration. FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations. September 22, 2021.

  3. U.S. Food and Drug Administration. Coronavirus (COVID-19) Update: FDA Takes Additional Actions on the Use of a Booster Dose for COVID-19 Vaccines. October 20, 2021.