Leading pediatricians group advises COVID-19 shots for young children

The nation’s largest professional organization for pediatricians on Tuesday reiterated its recommendation that children 6 to 23 months old receive an updated COVID-19 vaccination, putting it at odds with new Trump administration guidelines.

The American Academy of Pediatrics also loosened its recommendations for those 2 to 18 years old, from a blanket recommendation for a vaccine against the virus to a recommendation only for children with certain medical conditions that put them at higher risk for severe COVID-19.

That too creates a gap between AAP and new federal guidelines: The Centers for Disease Control and Prevention in May recommended the vaccine only for children 6 months to 17 years old who are "moderately or severely immunocompromised."

Trusting the science

The CDC and AAP both say any healthy child should be able to obtain the vaccine if a doctor and parent agree it is appropriate.

Although COVID-19 causes fewer deaths than a few years ago, there are still hundreds of people in New York every day hospitalized with the virus.

The academy harmonized its guidelines with the CDC in 1995, and this is the first significant divergence since then, said Dr. David Higgins, a national spokesperson for AAP and an assistant professor of pediatrics at the University of Colorado medical school.

Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine, said parents can trust AAP because its recommendations are science-based.

"For families, that's really important, that if you're going to make a recommendation, you base it on real data, not hypotheses or suggestions, but what actually has occurred," she said.

Until May, the federal government also recommended vaccines for children 6 to 23 months old, but longtime vaccine skeptic Robert F. Kennedy Jr., the Secretary of Health and Human Services, reversed that recommendation. The CDC, which is part of HHS, later changed its guidelines as well.

Last month, AAP and several other major medical groups sued Kennedy and HHS for making what they called non-science-based changes on vaccines that are an "assault on science, public health and evidence-based medicine."

'Baseless political attacks'

HHS spokesman Andrew Nixon said in a statement that "AAP is undermining national immunization policymaking with baseless political attacks" and accused it of "bypassing the CDC’s advisory process and freelancing its own recommendations." He also said the organization should "strengthen conflict-of-interest safeguards," although he did not provide evidence of conflicts.

AAP said in an email that it does not have conflicts of interest.

In the past, recommendations on vaccines were first made by a CDC panel of experts. But Kennedy fired all 17 members and created a new, smaller committee that includes vaccine skeptics. He no longer is allowing the committee to work with medical groups like AAP to put together vaccine guidelines. The panel has yet to issue recommendations on COVID-19 vaccines.

Children 6 to 23 months are at high risk for severe COVID-19 because their immune systems are still developing and have a harder time handling infections, said Dr. Asif Noor, chief of pediatric infectious diseases at NYU Langone Hospital — Long Island. 

In addition, "their small airways are vulnerable to having more inflammation and blockages," said Dr. Bruce Hirsch, an infectious disease doctor at Northwell Health. More small children will die or be hospitalized because of the change in CDC guidelines, he said.

Children under 1 year old have the highest rate of COVID-19 hospitalizations of any age group under 65, according to CDC data released in April, before the agency's change in vaccine policy.

Loosened guidelines

Older children have stronger immune systems and many have had COVID-19 or been vaccinated, so they often have mild infections, as long as they don't have certain medical conditions, Noor said.

Higgins said the academy loosened its guidelines for children 2 and older because of those factors "to target those at highest risk."

The CDC's recommendation of a vaccine only for immunocompromised children leaves out those with heart, lung and other diseases that put them at higher risk of severe COVID-19, he said.

Vaccination rates among children for the most recent COVID-19 vaccinations already are low: On Long Island, only 1.3% of children 4 and under, and 3.5% statewide, have received the 2024-25 COVID-19 vaccine, although that state Health Department data is incomplete. Nationwide, 5.6% of children 4 and under had received the vaccine as of April, according to more complete CDC data. 

CDC recommendations are important because insurance companies only are legally obligated to cover COVID-19 vaccine costs for CDC-recommended vaccines.

Higgins said the academy of pediatricians is working with insurance companies to try to ensure coverage, but even under new CDC guidelines, insurers are obligated to cover the vaccines because of the CDC's recommendation that children can obtain them if parents and doctors believe they are appropriate.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.