On August 19, 2025, the American Academy of Pediatrics (AAP) issued new recommendations regarding COVID-19 vaccinations for young children, significantly diverging from the guidance provided by the Centers for Disease Control and Prevention (CDC). This shift comes amid a rise in COVID-19 cases across the United States, leaving many parents and healthcare providers seeking clarity in the face of conflicting federal health directives.
The AAP now advises that all children aged 6 to 23 months receive a complete COVID-19 vaccine series. For children and adolescents aged 2 to 18, the AAP recommends a single dose for those identified as being at higher risk, marking a notable departure from previous guidance that advocated for vaccination across the entire age group. Higher-risk children include those with chronic medical conditions, those living in long-term care facilities, and those who have not been previously vaccinated.
In contrast, the CDC currently emphasizes a model of “shared clinical decision-making” for children aged 6 months to 17 years who are not moderately or severely immunocompromised. This approach allows families to engage in discussions with healthcare providers about vaccination rather than treating it as a standard recommendation. Such a framework, introduced after significant changes in leadership, including the appointment of Robert F. Kennedy Jr. as head of the Department of Health and Human Services, has created confusion among families and healthcare professionals alike.
The AAP has historically provided vaccine guidance since the 1930s, often in alignment with the CDC. However, the recent dismissal of the CDC’s Advisory Committee on Immunization Practices, which has typically advised the agency on vaccination matters, has raised questions regarding the reliability of CDC recommendations. In light of this, the AAP conducted its own review of current evidence, leading to the issuance of independent recommendations.
The new guidance highlights that while the risk of severe illness from COVID-19 has decreased for healthy older children, younger children and those with specific health conditions remain particularly vulnerable. Additionally, an independent review by the Vaccine Integrity Project, published on the same day as the AAP’s recommendations, confirmed that there have been no new safety concerns regarding COVID-19 vaccines, nor a decrease in their effectiveness.
As parents consider the AAP’s recommendations, several practical issues remain unresolved. Notably, adherence to these new guidelines does not guarantee insurance coverage, as policies and programs like the federal Vaccines for Children program are tied to CDC recommendations. This disconnect could lead to parents facing out-of-pocket expenses for vaccinations.
Moreover, the availability of COVID-19 vaccines for younger children is uncertain. Currently, only two vaccines are authorized for those under 12: Moderna’s vaccine, which is available only to children with high-risk conditions, and Pfizer’s vaccine, which may not have its authorization renewed. This situation could create a shortfall in vaccines, further complicating efforts to vaccinate children.
The implementation of these recommendations may vary by provider type. Some, such as pharmacists, adhere strictly to CDC guidelines, making it difficult to follow the AAP’s new recommendations unless policy adjustments are made.
Looking ahead, parents and healthcare providers are likely to encounter ongoing challenges as COVID-19 cases increase with the return to school. Much will depend on whether the Advisory Committee on Immunization Practices revises its recommendations in an upcoming meeting expected in September, as well as the continued availability of pediatric COVID-19 vaccines. Until further clarity is provided, parents are encouraged to consult with pediatricians to determine the best protective measures for their children.
David Higgins, a pediatrician and member of the AAP, emphasizes the importance of understanding these new guidelines, stating that the AAP aims to support families in navigating these complex decisions. His views, while informed by his role, do not represent the official position of the AAP regarding immunization guidelines.
