include acute chest pain and shortness of breath or palpitations, generally occurring within a few days of the second dose. It's important to put it in context. COVID-19 infection itself is 16 times more likely to cause myocarditis than the COVID-19 vaccine.

Moderator: Does my child really need the COVID-19 vaccine?

Dr. Shulman: 191 children aged 5 to 11 have died since January 21, 2020, due to COVID-19. It is exciting that COVID-19 is now a vaccine preventable condition for five years and up. There are multiple recommended vaccines for children that have led to almost complete elimination of diseases. If vaccines were not available, studies estimate that the annual death toll of these diseases in children would be: Rubella - 17, Mumps - 39, Measles 441, Rotavirus - 20 to 60 (Loftus 2021). These numbers are not significantly different from the 191 deaths from COVID-19 that a COVID-19 vaccine can prevent. Vaccines have altered the course of these diseases and made them able to be prevented and, therefore, are recommended.

Moderator: My children are very afraid of needles or have many sensory sensitivities and do not do well with vaccines. How can they get the COVID-19 vaccination?

Dr. Shulman: The Centers for Disease Control has a social story (cdc.gov/ncbddd/humandevelopment/COVID-19-Materials-for-People-with- IDD.html) about preparing for, and getting, a COVID-19 shot. It is geared toward teens and adults but it's easy to read to a child.

Moderator: Does being on certain medications, like a controlled medication, make getting the vaccine dangerous?

Dr. Shulman: Individuals with the most medical complications, on the most serious medications, were the ones who were offered the vaccine first. They are at the greatest risk of getting sick and greatest likelihood of having a severe outcome if they were to get infected with COVID-19. That's why the group of individuals with developmental disabilities has had more severe outcomes and greater risk of infection. And so being on medications, to me, means that the child is more at risk from COVID-19 and really needs the vaccine. There is no evidence that controlled substances or other medications would create more of a problem with getting the vaccine.

Moderator: Are children with genetic syndromes, epilepsy, and autism okay to receive the vaccine?

Dr. Shulman: None of these conditions are contraindications for the vaccine. They are not expected to result in increased side effects. Indeed, these children are at greater risk of getting sick from COVID-19 and they have more benefit to be gained from the vaccine than other children. The only real contraindication for the vaccine is allergy to the vaccine or its components, such as polyethylene glycol (a component of MiraLAX).

Moderator: You just mentioned MiraLAX. What about children TEXT Text Zip code to 438829 and locations will be sent to you CALL National COVID-19 Vaccine Hotline at 1-800-232-0233 who have Down syndrome, who may have gastrointestinal issues?

Dr. Shulman: There are very, very few ingredients in the vaccine that one could be allergic to. The only one that's been identified as allergenic is polyethylene glycol, which is in MiraLAX. This is the good news. If your child has ever been given MiraLAX and hasn't had an allergic reaction, they're not allergic to the vaccine.

Moderator: Should parents of children who have cardiac problems be worried about getting their child a COVID-19 vaccine?

Dr. Shulman: Getting a heart complication is 16 times more TTY National COVID-19 Vaccine Hotline at 1-888-720-7489 likely from COVID-19 infection than the vaccine. A child who has an underlying heart problem falls into a high-risk category; if they were to get COVID-19, they would have a greater likelihood of death. Getting the vaccine is a protective action. My very first patient who got vaccinated had a heart transplant. You cannot get more complex than this.

Moderator: What are your recommendations for children who PHARMACIES Walgreens (news.walgreens.com/press-center/news) and Rite Aid (riteaid.com/covid-19/minors), amongst other pharmacies, provide COVID-19 vaccines for 5 to 11-year-olds may be nonverbal or may not be able to explain to their parents if their chest hurts?

Dr. Shulman: Nonverbal children show their distress by not eating, drinking, sleeping, or playing. All these signal that they need a physical examination. Always look at your children's day-to-day behavior to see if it's changed in some way.

Moderator: If a child has autism and is taking specific medication, can they be vaccinated without any problem?

Dr. Shulman: There's never a zero chance of a problem. PEDIATRICIAN OFFICES Check with your child's health care provider about scheduling an appointment 56 January 2022 • EP Magazine | 2022 EP GUIDE Children with autism, and who have medical problems that need to be treated with medication, are at much greater risk of having a poor outcome from getting COVID-19. They are not at increased risk for