AAP recommends all young and high-risk children get vaccinated against COVID-19, diverging from CDC policy
August 19, 2025
Melissa Jenco, Senior News Editor
Article type:
AAP Policy
Topics:
COVID-19,
Infectious Diseases
,
Vaccine/Immunization
For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.
The AAP recommends all young children ages 6-23 months get vaccinated against COVID-19 along with older children in certain risk groups, based on evidence on who can benefit the most from the vaccine.
The guidance differs from federal policy that removes routine recommendations for healthy children but allows vaccination after a conversation with a health care provider. AAP published its COVID-19 vaccine recommendations Tuesday along with a revised child and adolescent immunization schedule that also includes updated guidance on respiratory syncytial virus (RSV) immunizations and flu vaccines.
“It’s clear that we’re in a different place in the pandemic than we were four or five years ago in terms of risks to healthy older kids,” said Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases (COID). However, “the risk of hospitalization for young children and those with high-risk conditions remains pretty high.”
The rate of COVID-19 hospitalization for children under 2 years is the highest among pediatric age groups and for children ages 6-23 months, it is comparable to people ages 50-64 years, according to the Centers for Disease Control and Prevention (CDC). More than half of these young children hospitalized for COVID- 19 did not have an underlying medical condition.
All children ages 6-23 months without a contraindication should get vaccinated with a 2025-’26 COVID vaccine formula regardless of whether they previously received any doses or have had a SARS-CoV-2 infection, according to the AAP policy Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents. The policy details the number of doses needed based on vaccination history.
For children ages 2-18 years, the AAP recommends a single dose of age-appropriate 2025-’26 COVID-19 vaccine regardless of vaccination status for those who
- are at high risk of severe COVID-19,
- are residents of long-term care facilities or other congregate settings,
- have never been vaccinated or
- have household contacts at high risk for severe COVID-19.
Children not in one of these groups whose parent or guardian desires their protection from COVID-19 also should be offered a single dose of the updated vaccine.
The guidance differs from that of the CDC, which no longer recommends routine COVID vaccination for healthy children. Under CDC guidance, children can be vaccinated after a discussion with a health care provider. However, shared clinical decision-making can be difficult to implement because it lacks clear guidance and does not emphasize the importance of vaccinating people at high risk of severe disease.
In early July, the AAP and other major medical groups sued Health and Human Services Secretary Robert F. Kennedy Jr. for unilaterally removing routine vaccination recommendations, without scientific evidence. The AAP also has been critical of Kennedy replacing members of the CDC’s Advisory Committee on Immunization Practices with new people who have espoused anti-vaccine viewpoints. The AAP announced in June it would continue to publish its own vaccine recommendations and schedule. It has a long history of providing evidence-based guidance on vaccines.
COID crafted the AAP’s COVID-19 vaccine guidance after consultation with a variety of experts and a thorough review of recent scientific data. The AAP has been collaborating with professional societies, payers and partner organizations to share approaches for developing evidence-based clinical guidance on COVID, flu and RSV for the upcoming respiratory virus season. The societies also have been collaborating with the University of Minnesota’s Center for Infectious Disease Research and Policy’s Vaccine Integrity Project.
“We were able to review the most recently available data on COVID-19 vaccine safety and effectiveness, as well as the recent data on risk of hospitalization across different age groups and risk conditions,” Dr. O’Leary said. “We worked with a diverse group of experts, including COID members, outside consultants and many partner societies, to craft our guidance. We strongly considered keeping a universal recommendation, but because it was clear that there are some children definitely at higher risk, we felt that emphasizing those risk groups was important, while still leaving room for vaccination for anyone who desires it."
Under the AAP guidance, any available COVID-19 vaccine appropriate by age and health status can be used. The Food and Drug Administration (FDA) recently updated licensing for Moderna’s Spikevax vaccine to cover people ages 6 months through 64 years with at least one underlying condition that puts them at high risk for severe disease and for everyone 65 years and older.
Novavax’s Nuvaxovid vaccine is licensed for people ages 12-64 years with an underlying condition that puts them at high risk for severe disease and everyone 65 years and older.
The AAP is monitoring reports the FDA may not renew emergency use authorization for Pfizer’s COVID-19 vaccine for young children.
Resources
- AAP policy Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents
- Information from the AAP on COVID-19 vaccine administration, storage and handling, reporting, and patient education
- Information for parents from HealthyChildren.org on when children should get a COVID vaccine
Copyright © 2025 American Academy of Pediatrics