As millions of children across the nation prepare to go back to school this fall, many will face challenges due to ongoing health, economic, and social consequences of the pandemic. Children may be uniquely impacted by the pandemic, having experienced this crisis during important periods of physical, social, and emotional development, and some have experienced the loss of loved ones. Further, households with children have been particularly hard hit by loss of income, food and housing insecurity, and disruptions in health care coverage, which all affect health and well-being. Public health measures to reduce the spread of the disease also led to disruptions or changes in service utilization, difficulty accessing care, and increased mental health challenges for children. Young children are still not eligible for vaccination, and though children are likely to be asymptomatic or experience only mild symptoms, they can contract COVID-19. Children may face new risks due to the rapid spread of the Delta variant, and some children who contract COVID-19 experience long-term effects from the disease.  Many of these effects have disproportionately affected low-income children and children of color, who faced increased health and economic challenges even prior to the pandemic. This brief examines how the COVID-19 pandemic has affected the health and well-being of children, explores recent policy responses, and considers what the findings means for the back-to-school season amidst new challenges due to the recent increase in cases and deaths. Key findings include:

• During the pandemic, some children experienced disruptions in routine vaccinations or preventive care appointments and difficultly accessing care, particularly dental and specialized care. Use of telemedicine has increased but not enough to offset declines in service utilization overall.
• Children’s mental health service utilization declined amid elevated symptoms of depression, anxiety, and psychological stress for children and parents.
• Households with children have experienced significantly higher rates of economic hardships throughout the pandemic compared to households without children, leading to increased barriers to adequately addressing social determinants of health. Black, Hispanic, and other people of color have been disproportionately impacted by the pandemic’s economic effects.
• Though the risk of severe illness from COVID-19 is lower for children than adults, over 43,000 children are estimated to have lost a parent due to COVID-19, with Black children being disproportionately impacted by parent death.
• Most children are likely to be back in the classroom this fall, but many still face health risks due to their or their teachers’ vaccination status. Some states and school districts are beginning to announce mask or vaccine requirements while others are banning vaccine or mask mandates for schools.

Recent policy developments, most notably the American Rescue Plan Act and the American Families Plan, attempt to alleviate some of the existing and pandemic-induced issues impacting children’s health and well-being. However, there is still uncertainty around what back to school will look like this fall, and the transition to “the new normal” may be more difficult for some. Schools, parents, and policymakers may face additional pressure to address the ongoing effects of the pandemic on children.

Children’s Health Care Disruptions and Mental Health Challenges

The pandemic has led to delays in child vaccinations and preventive care. KFF analysis of the Household Pulse Survey from June 23 – July 5, 2021 estimates 25% of households with children have a child who has missed, delayed, or skipped a preventive appointment in the past 12 months due to the pandemic (Figure 1). Preliminary Medicaid administrative data confirms this pattern, showing that when comparing March 2020 – October 2020 to the same months before the pandemic in 2019, there were approximately 9% fewer vaccinations for children under 2 and 21% fewer child screening services. Rates for primary and preventative care among Medicaid beneficiaries show signs of rebounding in more recent months with service use reflecting pent-up demand, but it is unclear whether this trend will continue and make up for the millions of services missed early in the pandemic. Another recent study similarly reports vaccinations for all children declined sharply after March 2020. The study also finds vaccinations have completely recovered for children under 2 but have only partially recovered for older children.

Children also experienced difficulty accessing and disruptions in specialty and dental care. Parents have reported delaying dental care or difficulty accessing dental care for their child, and there were 39% fewer dental services for Medicaid/CHIP beneficiaries under 19 when comparing the pandemic months March 2020 – October 2020 to the same months in 2019. Children with special health care needs experienced difficulties accessing specialized services, especially services that could not be conducted via telehealth.

Children’s utilization of telemedicine services has increased since the pandemic, but the increase has not offset the decreases in service utilization overall. Preliminary data suggest that telehealth utilization for Medicaid/CHIP beneficiaries under 19 increased rapidly in April 2020 and remains higher than before the pandemic. 23% of households with children surveyed by the Household Pulse Survey from June 23 – July 5, 2021 reported a child having a telehealth appointment in the past 4 weeks (Figure 1). Throughout the pandemic, the federal government and states have taken action to expand access to telehealth services. While telehealth utilization has increased, the increase has not offset the decreases in service utilization overall, and barriers to accessing health care via telehealth may remain, especially for low-income patients or patients in rural areas.

Children’s mental health and mental health service utilization has worsened since the start of the pandemic. The pandemic caused disruptions in routines and social isolation for children, which can be associated with anxiety and depression and can have implications for mental health later in life. Also, research has shown that as economic conditions worsen, children’s mental health is negatively impacted. Parents with young children reported in October and November of 2020 that their children showed elevated symptoms of depression, anxiety, and psychological stress and 22% experienced overall worsened mental or emotional health. Recent studies by the Centers for Disease Control and Prevention (CDC) find children’s emergency department visits increased during the pandemic for mental health-related emergencies and suspected suicide attempts by children ages 12 to 17. At the same time, mental health service utilization has declined, with preliminary data for Medicaid/CHIP beneficiaries suggesting there have been approximately 34% fewer mental health services when comparing the pandemic months March 2020 – October 2020 to the same months in 2019. Private mental health care claims also decreased from 2019 to 2020. There has been an increase in access to mental health care through telehealth, but there remain technological and privacy barriers to accessing mental health services via telehealth for some children.

Parental stress and poor mental health due to the pandemic can negatively affect children’s health. A previous KFF analysis finds economic uncertainty has led to increased mental health challenges, especially for adults in households with children and specifically mothers in those households. Further, 46% of mothers who reported a negative mental health impact due to the pandemic were not able to access needed mental health. Parental stress can negatively affect children’s emotional and mental health, harm the parent-child bond, and have long-term behavioral implications. Maternal depression can worsen child health status and lead to less preventative care. Additionally, parental stress and financial hardship can lead to an increased risk of child abuse and neglect. Early evidence shows declines in child abuse during the pandemic, though it is unclear if that is due to decreased reporting or due to social policy interventions during the pandemic. Children’s existing and pandemic-induced mental health challenges may have implications for the transition back to school and indicate children may need additional mental health support when they return to school.

Pandemic-related challenges in children’s access to health care built on a system that was sometimes not meeting needs even before the pandemic, especially for low-income children. In 2019, 23% of children living in households with incomes below 100% of the federal poverty level (FPL) were estimated to have not received a preventative check-up in the past 12 months and 26% did not see a dentist for a preventive visit during the past 12 months (Figure 2). Some children with mental health needs were not receiving care, with an estimated 29% of the lowest income children who needed mental health services not able to access care (Figure 2). The pandemic may have made it even more challenging for children already experiencing difficulties accessing care and likely worsened existing disparities in access to needed care for children of color, children with special health care needs, children in low-income households, and children living in rural areas.

The Economic Downturn and Children’s Well Being

Following the onset of the COVID-19 pandemic, many families with children were faced with unemployment and income loss and continue to face economic hardship. Throughout the pandemic, households with children were consistently more likely to report job or income loss, with more than half of households with children reporting losing income between March 2020 and March 2021.¹  While national indicators signaling job and income loss have moderated in recent months, they are still not at pre-pandemic levels. KFF analysis of the Census Bureau’s Household Pulse Survey from June 23 – July 5, 2021 found 12% of adults with children in the household applied for Unemployment Insurance (UI) benefits and 23% experienced loss of income in the past 4 weeks (Figure 3). These rates were significantly higher compared to adults without children in the household.

Loss of family income affects parents’ ability to provide for children’s basic needs. KFF analysis of the Census Bureau’s Household Pulse Survey also found that among adults reporting income loss in the past 4 weeks, 91% of adults with children in the household reported difficultly paying for expenses in the past week, 20% reported not having confidence in their ability to make their next month’s housing payment, and 32% reported food insufficiency (Figure 4). All of these rates are significantly higher for adults living in households with children than adults living in households without children. A large body of research shows that economic instability is a social determinant of health outcomes for children.

Further, Black, Hispanic,²  and other households of color have been disproportionately impacted by the pandemic and its economic effects. In 2019, Black and Hispanic children were nearly three times more likely to be living in poverty than Asian and White children, and food insufficiency rates before the pandemic were three times higher for Black households and two time higher for Hispanic households when compared to White households. A recent report found Hispanic and Black households with children have experienced almost double the rate of economic or health-related hardships during the pandemic compared to White and Asian households with children. Overall, child poverty rates children have increased during the pandemic, especially among Hispanic and Black children.

Job and income loss may lead to disruptions in children’s health coverage, though increased coverage through Medicaid and CHIP is likely offsetting much of that decline. Roughly 2 to 3 million people between March and September 2020 have lost employer health benefits, a trend that built on years of coverage losses among children. From 2016 and 2019, the rate of uninsured children in the US started to increase despite reaching the lowest rate in history (4.7%) in 2016, with the rate of uninsured Hispanic children increasing more than twice as fast as the rate for non-Hispanic youth. Loss of coverage or coverage interruptions can negatively impact children’s ability to access needed care.^3 ,4 ,5  During the pandemic, Medicaid and CHIP provided a safety net for many children. Administrative data for Medicaid show that children’s enrollment in Medicaid and CHIP has increased between February 2020 and February 2021, a total increase of 3.2 million enrollees, or 9.1%, from child enrollment in February 2020 (Figure 5).

Children’s Health and COVID-19

While likely to be asymptomatic or experience only mild symptoms, children can contract COVID-19. Preliminary data through July 29, 2021 show there have been over 4 million child COVID-19 cases, and children with underlying health conditions may be at an increased risk of developing severe illness. Though a small percentage, some children who tested positive for the virus are now facing long haul symptoms, with multisystem inflammatory syndrome in children (MIS-C) the most-common complication that has impacted 4,000 children as of June 2, 2021. It is unclear how long symptoms will last and what impact they will have on children’s long-term health. Cases have risen in recent weeks due to the Delta variant, and children are making up an increasing share of new cases, with children making up 19.0% of cases for the week ending in July 29 compared to 14.3% since the pandemic began. Hospitalizations of children with COVID-19 have also been rising since early July, reaching 216 children, on average, being admitted to the hospital every day for the week of July 31 – August 6, 2021.

Eligible children have lower vaccination rates than the adult population, and some children remain ineligible for a vaccine. Children 12 and up are now able to be vaccinated against COVID-19, which reduces the risk of adolescents contracting, spreading, or experiencing severe symptoms from COVID-19. Approximately 37% of children ages 12-15 and 48% of children ages 16-17 have received at least one vaccine dose as of July 26, 2021. These rates are lower than the adult population, which reached 70% as of August 2, 2021. There is currently no COVID vaccine for children under the age of 12, so  some risk remains for that population to contract and spread the virus. Vaccine clinical trials are currently underway for children under 12, with authorization expected by the end of 2021. The KFF COVID-19 Vaccine Monitor recently reported that almost half of parents of children ages 12-17 say their child has received a COVID-19 vaccine or they intend to get them vaccinated right away. The report also found that parents’ vaccination intentions for their children are largely correlated with their own vaccination status and those who say their child’s school provided information on or encouraged COVID-19 vaccines are more likely to report their child has received a vaccine. The KFF COVID-19 Vaccine Monitor also found that parents are more cautious when it comes to vaccinating their child under 12, with about a quarter saying they would get their child between the ages of 5 and 11 vaccinated right away once the vaccine is authorized and four in ten saying they would wait and see.

Some children have experienced COVID-19 through the loss of one or more family members due to the virus. A study estimates that, as of Feb. 2021, 43,000 children in US have lost at least one parent to COVID-19. The study also finds Black children represent only 14% of children in the US but 20% of children who have lost a parent, and low-income communities and communities of color overall experienced higher COVID-19 case rates and deaths. Losing a parent can have long term impacts on a child’s health, increasing their risk of substance abuse, mental health challenges, poor educational outcomes, and early death. Further, the death of a loved one from COVID-19 may have occurred amid increased social isolation and economic hardship due to the pandemic. Estimates indicate a 17.5% to 20% increase in bereaved children due to COVID-19, indicating an increased number of grieving children who may need additional supports as they head back to school in the fall.

Policy Responses

Several policies passed during the pandemic provided financial relief for families with children. To address the economic fallout of the pandemic, the federal government passed relief bills that included direct financial relief for families, and evidence suggests material hardships that affect health, such as food insufficiency and financial instability, declined following stimulus payments. In addition, the March 2021 American Rescue Plan Act (ARPA) included targeted aid to families with children through the Child Tax Credit (CTC). The ARPA is projected to decrease the number of children living in poverty by over 40%, with the expanded CTC now reaching children previously too poor to qualify and giving families in the lowest quintile an average income boost of $4,470. Alleviating child poverty is associated with improved child health outcomes such as healthier birthweights, lower maternal stress, better nutrition, and lower use of drugs and alcohol.

Other recent policies directly target children’s health coverage or access to health care. To address health care coverage, the ARPA extended eligibility to ACA health insurance subsides for people with incomes over 400% of poverty and increased the amount of assistance for people with lower incomes. The ARPA also included incentives for states to expand Medicaid for low-income adults under the ACA and extend Medicaid postpartum coverage for up to 12 months, both of which could benefit the health and well-being of families.^6 ,7  The Child Tax Credit, expanded by the ARPA, is not taxable income, so expanding the tax credit will not count toward Medicaid eligibility. To address access to health care challenges, the federal government and many states are making policy changes to permanently expand access to telehealth services. In their most recent report to congress, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended more coordinated efforts by agencies to address the design and implementation of benefits and improve access to home and community-based behavioral health services for Medicaid/CHIP children with significant mental health needs. In addition, the Biden Administration created a program to provide relief for COVID-19 related funeral costs, but targeted services for bereaved children were not included.

Back to School

Most children are likely to be back in the classroom this fall, but many still face health risks due to their or their teachers’ vaccination status and increasing transmission due to the Delta variant. The vast majority of schools, 88% of schools with 4^th grade and 89% of schools with 8^th grade, in the U.S. offered hybrid or full-time, in-person learning in Spring 2021, according to a federal survey. Most of these schools, as well as others, are likely to be in-person in fall 2021. While many states allow for in-person learning decision to be made at the local level, nine states have mandated schools return to in-person learning for the 2021-22 school year as of June 2021. No states are requiring the COVID-19 vaccine for school attendance at this time, and some states have enacted legislation to ban vaccine mandates for school attendance. However, due to concerns over the Delta variant and rising cases, some local districts are beginning to require the COVID-19 vaccine for teachers and staff. There have been legal challenges to vaccine mandates, with a federal District Court in Texas recently upholding a Hospital’s mandatory COVID-19 vaccination policy for employees. The CDC recently updated their guidance for COVID-19 in schools, recommending masks for all staff and students regardless of vaccination status for in-person learning in the fall. While some states and school districts will require students and staff to wear masks at school, at least nine states have passed legislation to ban mask mandates for schools as of late July 2021. Recent KFF polling shows that about half the public overall supports K-12 schools requiring COVID-19 vaccination, but most parents are opposed, with divisions along partisan lines.

While returning to in-person learning can support children’s development and well-being, the transition back to school in the fall may be challenging for some children. Experts notes that in-person learning is beneficial for children’s social, emotional, and physical health and can provide access to important health services and address racial and social inequities. However, this school year will look different for many children due to COVID-19 prevention strategies and transitioning back to “the new normal” may be difficult for some, especially those who have adapted to new routines and virtual learning in the past year. Children’s mental health has worsened during the pandemic, which could make the transition back to school more challenging. Additionally, young children who have been home with parents during the pandemic may experience separation anxiety as they transition back to school or day care.

Schools and proposed policies may provide additional supports for children and families as they transition back to school. The increased Child Tax Credits began July 15^th and will continue monthly, but the enhanced CTC was only adopted for 2021. The American Families Plan put forth by the White House proposes to extend the CTC expansion through 2025 and make the credit permanently available to families with no earnings. The American Families Plan also proposes expanding school meals and access to healthy foods, making the summer EBT program permanent, and expanding SNAP eligibility for formerly incarcerated individuals. The American Families Plan also proposes a national paid family and medical leave program and universal pre-kindergarten, both of which research has shown have benefits for children’s health outcomes.^8 ,9   President Biden and congressional Democrats also recently released a reconciliation budget resolution that includes expanded child tax credits and investments in universal pre-k, child care, paid leave, and education. Other policy actions at the local level can also address children’s well-being. For example, schools and school districts can support students as they transition back to school by creating a safe in-person learning environment, providing staff and resources to support students having difficulty transitioning, ensuring staff and teachers have access to mental health resources, and developing a trauma-informed plan to respond to COVID-19 related trauma.

COVID-19 and the health care disruptions, mental health challenges, and economic hardships stemming from COVID-19 all have implications for children’s health and their transition back to school in the fall. While returning to in-person learning can support children’s development and well-being, uncertainty remains around what in-person learning will look like as cases rise due to the Delta variant and the transition to “the new normal” may be difficult for some children and their families. Recent policy developments attempt to address the ongoing effects of the pandemic on children, and schools, parents, and policymakers may face additional pressure to support children during this time.

1. KFF analysis of Census Bureau’s Household Pulse Survey. ↩︎
2. Federal surveys generally ask whether respondents are “of Hispanic, Latino, or Spanish origin.” This brief uses Hispanic. Persons of Hispanic origin may be of any race but are categorized as Hispanic. ↩︎
3. Jennifer DeVoe, et al., “Mind the Gap” in Children’s Health Insurance Coverage: Does the Length of a Child’s Coverage Gap Matter?”, Ambulatory Pediatrics: 8,2 (2008): 129-34. doi:10.1016/j.ambp.2007.10.003. ↩︎
4. Karyn Schwartz, Spotlight on Uninsured Parents: How a Lack of Coverage Affects Parents and their Families (Commission on Medicaid and the Uninsured, Kaiser Family Foundation, June 2007), http://kff.org/medicaid/issue-brief/spotlight-on-uninsuredparents-how-a-lack/. ↩︎
5. Martha Heberlein, et al., Medicaid Coverage for Parents under the Affordable Care Act (Georgetown University Center for Children and Families, June 2012), http://ccf.georgetown.edu/wp-content/uploads/2012/06/Medicaid-Coverage-for-Parents1.pdf. ↩︎
6. Madeline Guth and Meghana Ammula, Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021 (Kaiser Family Foundation, May 6, 2021), https://modern.kff.org/medicaid/report/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021/. ↩︎
7. Usha Ranji, Ivette Gomez, and Alina Salganicoff, Expanding Postpartum Medicaid Coverage (Kaiser Family Foundation, March 9, 2021), https://modern.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/ ↩︎
8. Maya Rossin-Slater and Lindsey Uniat, Paid Family Leave Policies and Population Health (Health Affairs, March 28, 2019), https://www.healthaffairs.org/do/10.1377/hpb20190301.484936/full/. ↩︎
9. Jorge Luis García, James Heckman, Duncan Ermini Leaf, and María José Prados, The Life-cycle Benefits of an Influential Early Childhood Program, National Bureau of Economic Research Working Paper Series, No. 22993 (December 2016), https://www.nber.org/papers/w22993. ↩︎

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

• As children around the country head back to school, nearly half of parents of children ages 12-17, the age group currently eligible to receive a COVID-19 vaccine, say their child has already been vaccinated (41%) or they will get the vaccine right away (6%). The vaccination status of children closely mirrors that of parents, with larger shares of older parents, Democrats, those with higher incomes and college degrees (all demographic groups with higher vaccine rates among adults), saying their child is vaccinated compared with their counterparts. Nearly four in ten Republican parents (37%) and half of parents who are unvaccinated themselves say they will “definitely not” get their 12-17 year-old vaccinated.
• Parents of younger children who are not yet eligible to be vaccinated continue to take a cautious approach to COVID-19 vaccines, with four in ten parents of children under 12 saying that once a vaccine is authorized for their child’s age group they will “wait a while to see how it is working” before getting their child vaccinated. About half of parents, regardless of their child’s age, say they are very or somewhat worried about their child getting seriously sick from coronavirus.
• For parents of unvaccinated teens, their top concerns about the COVID-19 vaccine center around the potential for long-term or serious side effects in children. However, we also find that as surveys of adults have identified, Hispanic and Black parents are more likely than White parents to cite concerns that reflect access barriers to vaccination, including not being able to get the vaccine from a trusted place, believing they may have to pay an out-of-pocket cost, or difficulty traveling to a vaccination site. A larger share of Hispanic parents than White parents also reports being concerned about needing to take time off work to get their child vaccinated.
• Few working parents – particularly those with lower incomes – say their employer offers them paid time off to get their children vaccinated or care for them if they experience vaccine side effects. One quarter of working parents of unvaccinated 12-17 year-olds say they would be more likely to get their child vaccinated if their employer offered them paid time off to do so.
• Four in ten parents of children ages 12-17 say their teen’s school provided information about COVID-19 vaccines for children or encouraged parents to get their children vaccinated. Those who say their school did either one of these things are more likely to say their child has received a COVID-19 vaccine than parents who say their school did not do these things, even after controlling for other demographic factors associated with higher vaccination rates, suggesting that schools could play a role in increasing vaccine uptake among 12-17 year-olds.
• A majority (58%) of parents of 12-17 year-olds say their child’s school should not require students to be vaccinated for COVID-19, and a similar share (54%) of parents of all school-age children say schools should not require vaccination even once the FDA has fully approved the use of a COVID-19 vaccine in children. Majorities of Democrats and parents of children who are already vaccinated support schools requiring vaccinations in both scenarios, while majorities of Republican parents and those whose children are unvaccinated are opposed.
• More than six in ten (63%) of all parents of children who attend school think their child’s school should require unvaccinated students and staff to wear masks at school, although most Republican parents (69%) oppose such a requirement and parents of unvaccinated children are evenly divided.
• Pediatricians continue to be a top trusted source of information on COVID-19 and kids, though most parents have not yet talked to their child’s pediatrician about the vaccine. Among parents of teens who discussed the vaccine with their pediatrician, most say the doctor recommended their child get vaccinated, and three-quarters of those whose pediatrician recommended vaccination say their child has received at least one shot.
• A majority of parents say they have talked about the COVID-19 vaccines with their 12-17 year-olds, including almost half who say they have discussed the vaccines “a lot.” Among parents of unvaccinated teens, four in ten say their child has expressed concerns about getting a COVID-19 vaccine and 12% say their child has said that they want to be vaccinated.

Parents and COVID-19 Vaccines

COVID-19 Vaccination Status of Parents

One way for parents to protect their children from the risk of COVID-19 is to get vaccinated themselves. The latest KFF COVID-19 Vaccine Monitor finds 61% of parents say they have personally received at least one dose of a COVID-19 vaccine, which is somewhat lower than the 71% among adults without children (largely due to the fact that parents are younger on average than non-parents).

Among parents, some groups stand out as having lower vaccination rates than others, largely reflecting differences seen among the general population. For example, about half of those without health insurance (56%), Republican parents (54%), those with incomes under $40,000 per year (53%), parents ages 18-39 (50%), those without a college degree (49%), and Black parents (46%) say they have not received a COVID-19 vaccine.

Vaccination Intentions Among Parents Of Children Currently Eligible For COVID-19 Vaccination

Among parents of children ages 12-17, for whom the Pfizer COVID-19 vaccine is currently authorized, 41% now say their child has received at least one dose of a vaccine, up from 34% in June¹ . An additional 6% of parents of 12-17 year-olds say they intend to get their child vaccinated “right away.” Nearly one quarter of parents (23%) say they want to “wait and see” how the vaccine is working before getting their adolescent child vaccinated, while one in ten (9%) say they will only get their child vaccinated “if their school requires it,” and one in five say they will “definitely not” vaccinate their child.

Not surprisingly, parents’ vaccination intentions for their children are largely correlated with their own vaccination status. Six in ten parents who have received the vaccine themselves say their 12-17 year-old is vaccinated, compared to just 4% of unvaccinated parents. Among parents who have not been vaccinated themselves, half say they will “definitely not” vaccinate their child.

Besides vaccination status, parents’ vaccination intentions for their children differ along similar lines as adults overall. Parents who identify as Democrats, older parents, and those with higher levels of income and education are more likely to say their child is already vaccinated or they will get them vaccinated right away. Notably, nearly four in ten (37%) Republican parents say they will “definitely not” get their 12-17 year-old vaccinated.

While there have been gaps in COVID-19 vaccine uptake among adults by race and ethnicity, the current survey does not find a statistically significant difference in child vaccination uptake between Hispanic, Black, and White parents. However, White parents of children ages 12-17 are twice as likely as Hispanic parents to say they will “definitely not” get their child vaccinated (24% vs. 12%).

Parents’ intentions towards the COVID-19 vaccine for 12-17 year-olds are not necessarily a reflection of their behaviors with regards to other childhood vaccines. The vast majority of parents (90%) say they normally keep their children up-to-date with recommended vaccines such as the measles, mumps, and rubella (MMR) vaccine, while just 9% say they have delayed or skipped some childhood vaccines for their children. Yet even among parents of 12-17 year-olds who say their children are up-to-date on other childhood vaccines, fewer than half (43%) say their child has received a COVID-19 vaccine. (The sample of parents of 12-17 year-olds who have skipped or delayed other vaccines is too small for analysis.)

Just over half of parents (54%) say their child normally gets a flu vaccine each year. Among parents of 12-17 year-olds who say their child normally gets a flu shot, 57% say their adolescent has received a COVID-19 vaccine, which is twice the share of parents who say their child does not normally get a flu vaccine who have gotten the COVID-19 vaccine (25%).

Vaccination Intentions Among Parents Of Younger Children

While uptake of COVID-19 vaccines among 12-17 year-olds has increased over time, parents continue to report a more cautious attitude when it comes to vaccinations for children younger than 12. About a quarter (26%) of parents of children between the ages of 5-11 say they will vaccinate their child “right away” once a vaccine is authorized for their age group, as do one in five parents with children under 5. Four in ten parents in each age group say they will “wait and see” how the vaccine is working before having their younger child vaccinated. One-quarter say they will “definitely not” get their 5-11 year-old vaccinated and three in ten parents say the same about their children under age 5.

Parents’ Concerns and Reasons For Holding Off On Child COVID-19 Vaccinations

Parents of unvaccinated children ages 12-17  cite a range of concerns when it comes to vaccinating their children for COVID-19, with safety and side effects at the top of the list. A large majority (88%) of these parents say they are “very” or “somewhat” concerned that not enough is known about the long-term effects of the COVID-19 vaccine in children, and nearly as many (79%) say they are concerned their child might experience serious side effects from the COVID-19 vaccine. Nearly three-quarters of parents of unvaccinated adolescents (73%) report being concerned that the vaccine may negatively impact their child’s fertility in the future, even though the CDC states there is “no evidence that any vaccines, including COVID-19 vaccines, cause female or male fertility problems.”²  Two-thirds of parents of unvaccinated adolescents (65%) say they are concerned that their child might be required to get the COVID-19 vaccine even if they don’t want them to.

Notably, parents whose teens are unvaccinated but who have received a COVID-19 vaccine themselves are somewhat less likely than unvaccinated parents to express concern that their child will experience serious vaccine side effects (70% vs. 86%), that the vaccine might impact their child’s future fertility (58% vs. 85%), and that they will be required to get the vaccine even if the parent doesn’t want them to (50% vs. 78%).

A smaller share of parents overall cite concerns that may reflect access barriers to getting a COVID-19 vaccine for their child, though many of these concerns are more prevalent among Hispanic and Black parents than they are among White parents. For example, half (49%) of Hispanic parents of unvaccinated adolescents are concerned they might need to take time off work to get their child vaccinated or care for them if they experience side effects, twice the share of White parents (24%) who express the same concern. Similarly, among parents of unvaccinated 12-17 year-olds, larger shares of Hispanic and Black parents compared to White parents are concerned that they won’t be able to get their child the vaccine at a place they trust, they might have to pay an out-of-pocket cost to get their child vaccinated, or they will have difficulty traveling to a vaccine site for their child.

In addition to these concerns, many parents of unvaccinated 12-17 year-olds view the vaccine as a bigger risk to their child’s health than getting sick from COVID-19. Overall, six in ten (62%) parents of 12-17 year-olds say becoming infected with coronavirus is a bigger risk to their child’s health than getting the COVID-19 vaccine, while about half as many (34%) say getting the vaccine is a bigger risk. The share saying the vaccine is a bigger risk rises to 55% among Republican parents and 73% among parents who are unvaccinated themselves. Among parents of unvaccinated 12-17 year-olds, 55% say the vaccine is a bigger risk, including 91% of those who say they will “definitely not” get their child vaccinated.

When parents of adolescent children who have not yet been vaccinated are asked to name in their own words the main reason why their child has not received a COVID-19 vaccine, the top reasons include that not enough is known about the vaccines or wanting more research on the vaccines in children (19%), they are concerned about side effects (13%), their child does not want the vaccine (13%), they do not believe a vaccine is necessary (7%), and they don’t trust the vaccines (5%).

Potential Role Of Employers In Facilitating COVID-19 Vaccinations For Children

Seven in ten parents of children under age 18 say they are employed, including six in ten who are employed full-time. More than a third of employed parents say their employer offers them paid time off to get a COVID-19 vaccine (39%) or to recover from side effects themselves (35%). However, most say their employer does not provide paid time off for them to get their children vaccinated (36%) or they are not sure if their employer offers this (42%). Similar shares say the same about paid time off to care for a child experiencing vaccine side effects.

Notably, parents with lower household incomes are even less likely than those earning higher incomes to say their employer provides paid time off for either their own vaccination and side effects or that of a child.

Among employed parents of unvaccinated 12-17 year-olds, one-quarter say they’d be more likely to get their child vaccinated if their employer gave them paid time off, while somewhat smaller shares of this group say they’d be more likely to vaccinate their child if their employer arranged for a medical provider to come to their workplace to vaccinate children and families (19%), or provided free transportation to a vaccine site (14%).

With lower rates of reported COVID-19 vaccination among parents with lower incomes, employer policies have the potential to reduce these income gaps somewhat. For example, just 29% of employed (non self-employed) parents with household incomes under $90,000 say their 12-17 year-old has been vaccinated for COVID-19 compared to over half (54%) of employed parents with higher incomes. Among employed parents with incomes under $90,000, an additional one in five say they’d be more likely to get their child vaccinated if their employer offered them paid time off, and some say they’d be more likely to vaccinate their child if their employer arranged for a medical provider to vaccinate children and families at their workplace (14%) or provided free transportation to a vaccination site (12%).

Parents’ Worries About Kids and COVID-19

While research has shown that children are less likely than adults to become seriously ill from coronavirus infection, parents may nevertheless worry about their children being exposed or passing an infection on to other family members, particularly when it comes to children under the ages of 12 who are not eligible for COVID-19 vaccination. The latest KFF COVID-19 Vaccine Monitor reports that about half of parents of children ages 12-17 (48%) and under age 12 (52%) say they are worried about their child getting seriously ill from coronavirus. Similarly, about half of parents across child age groups say they are worried about their child being exposed to coronavirus and passing it on to family members or that they may personally be exposed to coronavirus and pass it on to their child.

Across child age groups, Black and Hispanic parents are much more likely than White parents to say they are worried about personally getting sick, about their child getting sick, about their child infecting someone else in the family, and about personally passing an infection on to their child. For example, among parents of children ages 12-17, 71% of Hispanic parents and 64% of Black parents are worried about their child getting seriously sick from coronavirus compared to 38% of White parents.

The July KFF COVID-19 Vaccine Monitor found that despite being at higher risk for contracting the disease, unvaccinated adults are less likely than vaccinated adults to worry about getting sick from COVID-19. A similar pattern holds among parents. Parents of vaccinated children ages 12-17 are more likely than parents of unvaccinated children in this age range to worry about their child getting seriously sick from coronavirus (56% vs. 42%) and about their child becoming infected and passing the virus on to someone else in their family (60% vs. 44%).

Schools and COVID-19 Vaccines

With some schools around the country already open for the 2021-2022 school year and many others set to open later this month, this Vaccine Monitor report examines parents’ views on vaccines and other protective measures in their children’s schools. We find that while most parents of school-age kids say their children attended school at least partially online during the previous school year, a large majority expect school to happen all or mostly in person during the upcoming school year (87% of parents of 12-17 year-olds and 89% of parents of 5-11 year-olds).

Among parents of children ages 12-17 who are enrolled in school for the upcoming school year, about four in ten (42%) say the school has provided them with information about how to get a COVID-19 vaccine for their child and a similar share (40%) say the school has encouraged parents to get their children vaccinated. Higher-income parents are more likely than those with lower incomes to say their child’s school did either of these things; about half of parents with household incomes of $90,000 or more say their child’s school provided vaccine information or encouraged vaccination compared to between one-third and four in ten among parents with lower incomes.

Fewer parents of 12-17 year-olds say their child’s school asked about their child’s COVID-19 vaccination status (11%) or said that they will require students to be vaccinated in order to return to school in-person (7%).

Parents of 12-17 year-olds who say their child’s school provided information about COVID-19 vaccination are more likely than those whose school did not provide information to say their child has received a COVID-19 vaccine (58% vs. 32%). Similarly, about twice as many parents whose school encouraged vaccination report that their child is vaccinated compared to those whose schools did not (62% vs. 30%).

These differences may be at least partially due to differences in other demographic characteristics of parents whose schools provided information or encouraged vaccination compared to those who did not. However, using a statistical technique called multiple logistic regression, we find that parents whose children’s schools provided information or encouraged vaccination are more likely to say their child is vaccinated, even after controlling for demographic characteristics associated with child vaccination, including parents’ own vaccination status, age, race, ethnicity, education, income, party identification, urbanicity, and region. This suggests that more schools providing information and encouraging COVID-19 vaccination could contribute to higher vaccination rates among students.

Overall, most parents of children in the 12-17 age group currently eligible for vaccination say they do not think their child’s school should require students to get a COVID-19 vaccine (58%) while four in ten parents (42%) say their school should require this. Views on this question diverge along partisan lines, with two-thirds of parents who identify as Democrats (66%) saying their child’s school should require students to be vaccinated and nearly nine in ten Republican parents (87%) saying it should not. Majorities of White parents and Black parents say their school should not require students to be vaccinated, while Hispanic parents are more evenly divided on this question (51% should, 47% should not).

Not surprisingly, there is a huge divide in opinion of school vaccine mandates among parents by their child’s vaccination status: 75% of parents of children ages 12-17 who have received a COVID-19 vaccine say their child’s school should require vaccination while 83% of parents of unvaccinated children ages 12-17 say they should not.

Parents’ views on schools requiring COVID-19 vaccinations remain divided even when asked how they would feel if the FDA were to grant full approval for the use of a vaccine in children. Among all parents of school-age children (ages 5-17), just under half (45%) say that once a COVID-19 vaccine receives full FDA approval, “schools should require students to be vaccinated for COVID-19 as they do for most other diseases like measles and tuberculosis” while just over half (54%) say schools should not require COVID-19 vaccinations in this scenario.

Similar to the question about their own child’s school, majorities of Democrats, Hispanic parents, and parents of children who have already received a COVID-19 vaccine say schools should require students to receive a COVID-19 vaccine once one is approved by the FDA, while majorities of Republicans, Black parents, White parents, and parents of unvaccinated 12-17 year-olds say they should not.

In general, parents are more supportive of mask mandates in schools than they are of vaccine mandates. Over six in ten parents of children enrolled in school (63%) say their child’s school should require unvaccinated students and staff to wear masks while they’re in school while 36% say they should not. Previous Vaccine Monitor reports have shown that mask-wearing among adults divides largely along partisan lines and the same is true when it comes to opinions about mask mandates in schools. Large majorities of parents who identify as Democrats (88%) and independents (66%) say their child’s school should require masks while most Republican parents (69%) say they should not. In addition, larger shares of Black parents (83%) and Hispanic parents (76%) compared to White parents (54%) support a mask requirement at their child’s school. Among parents of 12-17 year-olds, a large majority (85%) of those whose child has received a COVID-19 vaccine say their school should require unvaccinated students and staff to wear masks while those whose child is unvaccinated are evenly split.

While some parents may be concerned about their child’s risk of exposure to coronavirus at school or in social settings, about four in ten parents of children ages 12-17 (41%) say they don’t know what share of their child’s close friends have been vaccinated for COVID-19 and about half (48%) say the same about their child’s schoolmates. Parents of vaccinated children are much more likely than parents of unvaccinated children to say all or most of their child’s friends (32% vs. 2%) and schoolmates (14% vs. 1%) are vaccinated, while parents of unvaccinated 12-17 year-olds are more likely to say they don’t know the vaccination status of their child’s friends (45% vs. 34%) and schoolmates (55% vs. 38%).

Sources of Information and Information Needs

Throughout efforts to vaccinate adults for COVID-19, the Vaccine Monitor has documented gaps in information about COVID-19 vaccines, including that Black and Hispanic adults and those with lower incomes have been more likely to say they don’t have enough information about vaccine side effects and access.

The latest survey finds that the same is true when it comes to parents’ feelings about information on COVID-19 vaccines for children. While about four in ten parents say they have enough information, over half say they don’t have enough information about the effectiveness (57%) or the potential side effects (60%) of the COVID-19 vaccines in children.

Larger shares of mothers, younger parents, Black and Hispanic parents, those with lower incomes, and parents without a college degree say they don’t have enough information about effectiveness and side effects of vaccines in kids compared to fathers, older parents, White parents, and those with higher incomes and college degrees.

Parents’ Trusted Sources Of Information On COVID-19 Vaccines For Kids

Overall, pediatricians are a top source for trusted information when it comes to COVID-19 vaccines and children. About eight in ten parents overall (78%) say they trust their child’s pediatrician “a great deal” or “a fair amount” to provide reliable information about COVID-19 vaccines for kids. Over six in ten also say they trust the CDC (66%) and their local public health department (62%) at least a fair amount, while a majority of insured parents trust their health insurance company (58%) and over half of working parents trust their employer (53%). Schools and other parents are lower on parents’ list of trusted information sources, with 44% saying they trust their child’s school or daycare for vaccine information and 38% saying the same about other parents they know.

Reflecting partisan divisions in trusted information sources among all adults in previous Vaccine Monitor reports, parents who identify as Republicans are far less likely than those who identify as Democrats to trust most sources of information, with the exception of pediatricians (who are highly trusted by parents across the political spectrum) and other parents (who rank lower as a trusted resource regardless of partisanship).

A key target group for information is parents of unvaccinated children ages 12-17, who are currently eligible to receive a COVID-19 vaccine. Among these parents, nearly two-thirds (64%) trust their child’s pediatrician at least a fair amount to provide reliable information about COVID-19 vaccines and children, but fewer than half trust any of the other information sources tested. Notably, among those who say they will “definitely not” vaccinate their child, four in ten (39%) say they trust their child’s pediatrician and fewer than one-third put at least a fair amount of trust in any of the other information sources included in the survey.

Parents’ Vaccine Conversations with Pediatricians And With Their Children

While pediatricians are a top trusted source of information, most parents have not yet discussed COVID-19 vaccinations with their child’s pediatrician. Three in ten parents of children under age 18 say they have talked to their children’s pediatrician about the COVID-19 vaccine, including a somewhat higher share of parents who have children between the ages of 12-17 (35%). Among parents of children in this age range who discussed the vaccine with their child’s pediatrician, 72% (one quarter of all parents of 12-17 year-olds) say the pediatrician recommended that their child get vaccinated for COVID-19.

Parents who say their child’s pediatrician recommended vaccination are about two and half times as likely to say their child has received a COVID-19 vaccine compared to parents who did not talk to a pediatrician or say the pediatrician did not recommend vaccination (75% vs. 31%). However, the extent to which a pediatrician’s recommendation was a deciding factor for these parents is unclear, since parents who are more inclined towards getting their children vaccinated for COVID-19 may have been more likely to initiate these conversations with pediatricians in the first place.

Parents more commonly report discussing the COVID-19 vaccine with their children than with their pediatrician. Among parents of 12-17 year-olds, nearly half (46%) say they have talked with their child about the vaccine “a lot” and another third (32%) say they have discussed it “some.” Parents with college degrees and those who have received the COVID-19 vaccine themselves are more likely to report discussing the vaccine with their adolescent children. In addition, more than six in ten parents of children who have received at least one dose of the vaccine say they have talked with their child “a lot” about the vaccine compared with about a third (35%) of parents of unvaccinated 12-17 year-olds.

About one-third of parents of children ages 12-17 say their child has expressed any concerns to them about getting a COVID-19 vaccine, including one quarter (24%) of parents of vaccinated children and four in ten (41%) parents of unvaccinated children.

Among parents of unvaccinated children ages 12-17, one in eight (12%) say their child has told them that they want to get the vaccine.

When asked to say in their own words the main concern their child has expressed, side effects are at the top of the list, with 29% of parents of children who expressed a concern saying this was their main concern (38% of parents of vaccinated children and 26% of unvaccinated). The second- and third-ranked concerns among parents of unvaccinated children who expressed concerns are not wanting to get the vaccine (16%) and concerns about long-term effects (14%). Among parents of vaccinated children who expressed concerns, 9% say their child was concerned about long-term effects and 8% expressed concerns about the safety of the vaccine.

This KFF COVID-19 Vaccine Monitor – Parents and the Pandemic was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted July 15-August 2, 2021 via telephone and online among a nationally representative sample of 1,259 adults who are the parent or guardian of a child under the age of 18 living in their household. The sample includes 351 parents reached through the July 2021 KFF COVID-19 Vaccine Monitor and 908 who were reached online through a probability-based online panel (SSRS Opinion Panel). The Vaccine Monitor respondents were reached through a random digit dial telephone sample of adults ages 18 and older (including interviews from 101 Hispanic parents and 64 non-Hispanic Black parents), living in the United States. Phone numbers used for the telephone component were randomly generated from cell phone and landline sampling frames, with an overlapping frame design, and disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents as well as those living in areas with high rates of COVID-19 vaccine hesitancy. The sample also included 43 parents by calling back respondents that had previously competed an interview on a KFF poll (n=11) or SSRS omnibus poll (n=32). The comparison sample of non-parents was also drawn from the July 2021 KFF COVID-19 Vaccine Monitor. See the July 2021 KFF COVID-19 Vaccine Monitor for further details on the telephone component.

For the online component, invitations were sent to panel members who previously identified as the parent of a child ages 5 to 17.  As with the telephone component, Hispanic and Black respondents were oversampled.  The SSRS Opinion Panel is a nationally representative probability-based web panel. SSRS Probability Panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS). ABS respondents are randomly sampled by MSG through the U.S. Postal Service’s Computerized Delivery Sequence (CDS). (b) from a dual-frame random digit dial (RDD) sample, through the SSRS Omnibus survey platform. Sample for the SSRS Omnibus is obtained through Marketing System Groups (MSG).

The combined telephone and online parent samples were weighted to match the sample’s demographics to the national parent population using data from the Census Bureau’s 2019 U.S. American Community Survey (ACS). Weighting parameters included sex, age, education, marital status, child age, and region, within racial/ethnic groups. The weights take into account differences in the probability of selection for each sample type (phone and web). This includes adjustment for the sample design and geographic stratification of the telephone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample of parents is plus or minus 4 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

This work was supported in part by grants from the Chan Zuckerberg Initiative DAF (an advised fund of Silicon Valley Community Foundation), the Ford Foundation, and the Molina Family Foundation. We value our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

1. The survey was conducted July 15 through August 2, with the bulk of interviews being conducted before the most recent data from the CDC indicating the increased risk of the Delta variant to both unvaccinated and vaccinated people. Therefore, the survey may not capture any recent uptick in child vaccinations due to the latest surge in cases. ↩︎
2. COVID-19 Vaccines While Pregnant or Breastfeeding (U.S. Centers for Disease Control and Prevention, June 29, 2021). Accessed August 9, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html ↩︎