It is always harder to act on a proposition than to take a passive stance. If something bad happens because we took an action, it feels like we are responsible. No parent wants to hurt their child, and even if there is a tiny chance of causing harm it is understandable why up to a third of American parents aren't getting their kids vaccinated voluntarily.
But unfortunately we are just as responsible for not acting. Seeing your child get sick, and worrying how bad it might get, and worrying about who else is about to get sick, should compel us to take control and choose the less risky proposition.
I’m sticking with the AAP, AAFP, FDA, and CDC recommendations, and an old school respect for expertise... and your post here reinforces all that! Thank you.
Thanks for a great article--as a pediatrician, I actually try to balance both numerator and denominator in helping my parents make decisions--such a tough time right now! I would love to hear more about type 1 diabetes risk post-COVID--but there may not be enough data to address this yet...
I'm curious if there are any new data related to incidence of Long COVID from breakthrough infections. Wondering if there are any updates since you last addressed this question in the summer. Thanks as always for your energetic commitment to this community even as you navigate the pandemic in your personal life.
A heartfelt thank you from a father of five for the work you do, the analytical brain cells you deploy, to provide this data and interpretation. Question -- have you seen / reviewed any meaningful data around natural immunity from prior infection? by covid variant (variant to variant), by severity of covid case, by age group?
i have but it certainly needs updating. happy to work on this for a future post. this question is going to be REALLY important for omnicron infections. in other words, we don’t know how long natural immunity lasts with omnicron. hopefully as long as with previous variants, but that’s not guaranteed especially since disease is less severe. answering this question will be key on when our next wave is (and how severe it is). anyways… yes, i’ll work on a post
Thank you very much!! We have some “internal household disagreement” on just how meaningful / powerful “natural immunity” is relative to age (of infected person), variant (of infection), timing (dates of infection), and (as well) what the “cumulative” impact is of prior infection + vaccination (+ booster). Any and all help appreciated…
Readers may make a cognitive mistake when they see "research out of the UK showing that long COVID19 is present in fewer than 2% of the population." The Office for National Statistics meant exactly what you said--about 1 person in every 50 in the UK has Long COVID. Not 2% of people who have had COVID, which would be an easy reading glitch. 2% of the entire population of the country, which includes people who have avoided infection with the virus so far.
Thank you for this clarification. I did indeed interpret it as "2% of people who have been infected". Do they also have a statistic for percentage of children? Or percentage of children who have been infected? This would be very interesting to know when making back to school decisions since we know many children are asymptomatic or have very mild infections that may not get tested.
Just tried to answer this question. It's pretty difficult. I wasn't able to find a good source of cumulative infections by age -- they only publish a daily percentage number by age group. However, with some very quick back of the envelope math (not precise but hopefully directionally accurate), you can take cumulative infections in the UK, discount by 25% for reinfection by the same individual (not clear this is a good estimate but we're running with it), divide by the total population to get a population wide infection rate, multiply by the number of people in the 2-11 age group (not clear this is a good assumption either, cumulative cases are not likely evenly distributed across age groups). That will give you the total number of people infected in the 2-11 age group (1.4M). If someone could find a real number here that would help tremendously with precision in the next part.
They do publish an estimate of the total number of people living with self-reported long COVID of any duration by age group, in the 2-11 bracket that's 44,000. That would indicate ~3% of cases in that age group result in some form of long COVID. They also break out that 40% of people experiencing long COVID have had symptoms > 52 weeks, and 36% say it has no impact on their day to day activities and 44% says it has "a little" impact, so you might discount the 3% a tad further if you would like to try to differentiate between a 6-week bout and/or mild symptoms and a longer lasting / severe situation.
You'd have to dig in the ONS website. They have the data, but usually don't explicitly mention the case rate in children in headline reports. They did publish case and death rate data about children in September 2021 in response to an enquiry. Anecdotally, it has been sweeping through schools ever since the schools reopened after the summer break. It has been common for the children of friends to be in classes where 1/4 to 1/2 of the kids are out with COVID at the same time (not out in self-isolation due to exposure). The most recent general COVID update from ONS is at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections
Thank you for your analysis and explanation. This is a good example of the importance about clearly communicating the basis for your analysis. It also is a good demonstration about the importance of nuance and the benefit of approaching this informed by denominator AND numerator, rather than either/or. I empathize with you and other parents with little ones under 5 and worry about my 3 year old granddaughter.
This is another clear, fact-based article. Your voice is one of the most rational out here. Could you concentrate a future post on the risk to older people - the category I am in. Is it greater or lesser than other age groups - infection, hospitalization, deaths - can you separate for or with Covid for the over 65 population? There is a fair amount of variability among my cohorts for fraternization, based less on real risk, than attitude toward risk-taking, perhaps. Thank you for all you do. A service to all of us. Maggie Burns
Love the update - I have been talking numerator/denominator - glad you brought it out.
HOWEVER - you neglected to take on the unintended consequences from the virus mitigation.
Sometimes the cure is worse than the disease -
How many kids are dead from mental health disorders BECAUSE of the pandemic mitigation?
How many kids are suffering from mental health disorders now - that may be victims shortly.
What are the effects of stunted development and what is that metric?
This IMHO is the only thing missing from your most excellent update and its importance to place into perspective the deaths from COVID mitigation over deaths from COVID.
How many 18 and unders from Anti-mask/Anti-vax households are suffering a myriad of mental illnesses because of the unstable, conspiracy-minded adults in the household?
Suicide from COVID mitigation is not relevant to this article.
Why Mental Health / Suicide not relevant to statistical analysis of COVID and children? Suicide is up since COVID mitigation has started March 2020.
IMHO -
Like any medication, side effects of a therapy must be addressed.
If we are going to analyze the metrics of numerator / denominator of all different aspects of treatment, then suicide which has been an "unintended consequence" of the therapies.
For shame you are mocking the mental health aspect - of 4 and unders - we are better than that.
and suicide is up why? what data exist that indicate any causal relationship between COVID vaccination or treatment and suicide? IMHO, your "cure is worse than the disease" warning echoes of all the opposition to social distancing, remote school, and other pandemic mitigation efforts attempted by the health authorities. That, and I would bet large sums of cash that the "increase in suicides" has been mightily assisted by access to guns, so we all might wish to start there (rather than "covid restrictions are killing us") in terms of saving lives.
i can think of a few but go to the US Surgeon General of the USA
QUOTE
“Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.” said Surgeon General Vivek Murthy. “The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating. The future well being of our country depends on how we support and invest in the next generation.
UNQUOTE
NEVER ASSUME Robert... Felix Unger was wise about what happens when someone assumes.
Wait... data? comparative data? and no, the bet is not lost. The presence of guns in a household is a key predictor of suicide, youth and adult (not even getting into accidental gun deaths or family on family gun activity). BTW, the impact of Covid "run amok" without social distancing (and other public health recommendations /'requirements) would also have been, to use a key word, "devastating"
Robert - you are right and you are mixing apples and oranges.
Guns are probably a key tool used - maybe not predictor but i get the point you are making.
Do not run with the idea that I thought nothing should be done.
We are at a unique time where the risk reward of a policy needs to be considered.
I care about every life but we can not have a zero tolerance for COVID deaths before we start to dial back mitigation tactics.
To think that kids wearing masks all day has no effect except to save lives is irresponsible. Kids are not dying - kids are being affected - dramatically affected.
As a father of two children under the age of 5, I am very sympathetic to how frightening the pandemic can be for parents and how it plays into our core instincts to protect our children (of course, not even mentioning all of the insane disruption it has created in our lives).
I really liked the way you broke down numerator vs. denominator thinking. It's a good label/framework for acknowledging how people are approaching the data from different perspectives and helps us be empathetic to other perspectives.
That said I am a bit disappointed to see numerator thinking validated as equal. Yes, denominator thinking is of little consolation if your kid ends up being in the numerator. However, the inherent flaw with numerator thinking is that it is biased towards whatever you decide to focus on. Not only can numerator thinking logic create fear for pretty much anything where the numerator is > 0, it is not a measure of risk and is also of no use in comparing relative risks and outcomes.
For example, we can look at the number of children hospitalized due to COVID per day and agree that it is a larger numerator than we would like and feel comfortable with. But our bias shows based on what we decide to focus on and pay attention to. It is equally valid to ask - how many children are falling behind in their schooling or social/emotional development? That number is likely millions and a much larger number. That we choose to focus on one numerator and not another is an act of bias.
"Denominator thinking" doesn't eliminate all of that bias, but it does help us analyze the risk involved in a situation and also compare relative risks to each other.
What are the consequences of having a child with a life-long disability? What are the consequences of having a child with a persistent illness for a matter of months or a few years? Phrased more relevantly to the American experience, what are the *costs* of either? Both?
Ah, it depends, doesn't it? It depends on the insurance and it depends on the parents' income.
Funny how the policy makers and leadership are by and large absolved from the pains of scarcity and so can literally afford to ignore numerator thinking. David, could financial security and Cadillac health insurance be your bias in dismissing numerator thinking?
Numerator thinking is absolutely EVERY bit as valid as denominator thinking. The key variance is risk tolerance, which when done correctly focuses on outcomes (thank you, Sidney Dekker). Heaven forbid one of my children end up permanently disabled, I will not be able to afford private care for them when they outlive me. So, no, avoiding COVID like the plague that it is until my infant is vaccinated is pretty key to a successful outcome for my baby.
(Two of my older kids, while with their other parents, caught COVID over the winter holidays--thankfully being fully vaccinated, they had mild cases and no loss of smell, which I am hoping is a reliable proxy for a lack of brain damage.)
I'm sorry to hear about your children catching COVID and I also hope that the mild case is a good proxy for lack of brain damage. I'm not trying to minimize how difficult or awful the situation is, for you or any others, by any means.
You can still use denominator thinking to come to the conclusion that the risks are unacceptably high for you and your family -- denominator thinking is not a proxy for being less safe or cautious. Sometimes it can actually makes us more cautious. What is important is looking at the risks in the context of how likely they are to happen multiplied by how bad the outcome is, and coming to your conclusion based on a risk adjusted analysis.
The example on educational and social/emotional development was perhaps a bit politically charged and so not the best one to use. But we all do risk assessments every day in our lives, when we send our kids to play sports, or jump on a trampoline, or climb a play structure that is a bit advanced for them, or get in a car. The important part is looking not just at the potential outcome but looking at it on a risk adjusted basis.
Thank you for this post. It provides great info for parents still navigating life with an unvaccinated child under 5. Do you have any further info regarding the delay of the Moderna under 5 trial? I actually had not heard anything about this until I read the Slate article you linked at the end of this post! A bit of a gut punch today. Can definitely relate to the author of the article.
Outstanding article. I was never in the military but as a grandpa of 3, the youngest being 2 and a half, I feel like every day is a walk through a minefield of virus bombs. Your explanations give the situation perspective which helps a lot. Thanks!
Are we pretty much dependent on Pfizer for a vaccine for children under 5? I've been following Moderna info too but wondering if there's really any chance of getting a Moderna vaccine for young children first given that they don't have EUA for under 18 yet....
Dr. Jetelina, An advocacy group for expedited vaccines for children under 5 has been created on FaceBook. Would you consider joining or advising on the best advocacy routes at this time? https://www.facebook.com/groups/635645747482854/?ref=share
Thank you for this important information. My son is stuggling with the decision of whether or not to go ahead and get his children, 15 and 13, boosted now, or wait to get the next one that comes out. This is based on his concern that they get the current booster and before enough time has elapsed, there is a new, better one available and they end up unable to get it for a time. What is your thinking on this concept - the current booster now vs. holding out for the next one? The children are in public schools and sports now.
It is always harder to act on a proposition than to take a passive stance. If something bad happens because we took an action, it feels like we are responsible. No parent wants to hurt their child, and even if there is a tiny chance of causing harm it is understandable why up to a third of American parents aren't getting their kids vaccinated voluntarily.
But unfortunately we are just as responsible for not acting. Seeing your child get sick, and worrying how bad it might get, and worrying about who else is about to get sick, should compel us to take control and choose the less risky proposition.
I’m sticking with the AAP, AAFP, FDA, and CDC recommendations, and an old school respect for expertise... and your post here reinforces all that! Thank you.
Thanks for a great article--as a pediatrician, I actually try to balance both numerator and denominator in helping my parents make decisions--such a tough time right now! I would love to hear more about type 1 diabetes risk post-COVID--but there may not be enough data to address this yet...
I appreciated this recent post by Emily Oster regarding recent reporting and (flawed) data on increased risk of diabetes: https://emilyoster.substack.com/p/diabetes-kids-and-covid?r=9vddq&utm_campaign=post&utm_medium=web&utm_source=direct
I'm curious if there are any new data related to incidence of Long COVID from breakthrough infections. Wondering if there are any updates since you last addressed this question in the summer. Thanks as always for your energetic commitment to this community even as you navigate the pandemic in your personal life.
Well done by a gifted epidemiologist.
A heartfelt thank you from a father of five for the work you do, the analytical brain cells you deploy, to provide this data and interpretation. Question -- have you seen / reviewed any meaningful data around natural immunity from prior infection? by covid variant (variant to variant), by severity of covid case, by age group?
i have but it certainly needs updating. happy to work on this for a future post. this question is going to be REALLY important for omnicron infections. in other words, we don’t know how long natural immunity lasts with omnicron. hopefully as long as with previous variants, but that’s not guaranteed especially since disease is less severe. answering this question will be key on when our next wave is (and how severe it is). anyways… yes, i’ll work on a post
Thank you very much!! We have some “internal household disagreement” on just how meaningful / powerful “natural immunity” is relative to age (of infected person), variant (of infection), timing (dates of infection), and (as well) what the “cumulative” impact is of prior infection + vaccination (+ booster). Any and all help appreciated…
Readers may make a cognitive mistake when they see "research out of the UK showing that long COVID19 is present in fewer than 2% of the population." The Office for National Statistics meant exactly what you said--about 1 person in every 50 in the UK has Long COVID. Not 2% of people who have had COVID, which would be an easy reading glitch. 2% of the entire population of the country, which includes people who have avoided infection with the virus so far.
Thank you for this clarification. I did indeed interpret it as "2% of people who have been infected". Do they also have a statistic for percentage of children? Or percentage of children who have been infected? This would be very interesting to know when making back to school decisions since we know many children are asymptomatic or have very mild infections that may not get tested.
Just tried to answer this question. It's pretty difficult. I wasn't able to find a good source of cumulative infections by age -- they only publish a daily percentage number by age group. However, with some very quick back of the envelope math (not precise but hopefully directionally accurate), you can take cumulative infections in the UK, discount by 25% for reinfection by the same individual (not clear this is a good estimate but we're running with it), divide by the total population to get a population wide infection rate, multiply by the number of people in the 2-11 age group (not clear this is a good assumption either, cumulative cases are not likely evenly distributed across age groups). That will give you the total number of people infected in the 2-11 age group (1.4M). If someone could find a real number here that would help tremendously with precision in the next part.
They do publish an estimate of the total number of people living with self-reported long COVID of any duration by age group, in the 2-11 bracket that's 44,000. That would indicate ~3% of cases in that age group result in some form of long COVID. They also break out that 40% of people experiencing long COVID have had symptoms > 52 weeks, and 36% say it has no impact on their day to day activities and 44% says it has "a little" impact, so you might discount the 3% a tad further if you would like to try to differentiate between a 6-week bout and/or mild symptoms and a longer lasting / severe situation.
My math may be completely wrong and someone please correct me if that's the case. Here is the data if you would like to look at it yourself: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/alldatarelatingtoprevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk
You'd have to dig in the ONS website. They have the data, but usually don't explicitly mention the case rate in children in headline reports. They did publish case and death rate data about children in September 2021 in response to an enquiry. Anecdotally, it has been sweeping through schools ever since the schools reopened after the summer break. It has been common for the children of friends to be in classes where 1/4 to 1/2 of the kids are out with COVID at the same time (not out in self-isolation due to exposure). The most recent general COVID update from ONS is at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections
Thank you for your analysis and explanation. This is a good example of the importance about clearly communicating the basis for your analysis. It also is a good demonstration about the importance of nuance and the benefit of approaching this informed by denominator AND numerator, rather than either/or. I empathize with you and other parents with little ones under 5 and worry about my 3 year old granddaughter.
This is another clear, fact-based article. Your voice is one of the most rational out here. Could you concentrate a future post on the risk to older people - the category I am in. Is it greater or lesser than other age groups - infection, hospitalization, deaths - can you separate for or with Covid for the over 65 population? There is a fair amount of variability among my cohorts for fraternization, based less on real risk, than attitude toward risk-taking, perhaps. Thank you for all you do. A service to all of us. Maggie Burns
Love the update - I have been talking numerator/denominator - glad you brought it out.
HOWEVER - you neglected to take on the unintended consequences from the virus mitigation.
Sometimes the cure is worse than the disease -
How many kids are dead from mental health disorders BECAUSE of the pandemic mitigation?
How many kids are suffering from mental health disorders now - that may be victims shortly.
What are the effects of stunted development and what is that metric?
This IMHO is the only thing missing from your most excellent update and its importance to place into perspective the deaths from COVID mitigation over deaths from COVID.
How many 4s and unders are committing suicide?
How many 18 and unders from Anti-mask/Anti-vax households are suffering a myriad of mental illnesses because of the unstable, conspiracy-minded adults in the household?
Suicide from COVID mitigation is not relevant to this article.
Why Mental Health / Suicide not relevant to statistical analysis of COVID and children? Suicide is up since COVID mitigation has started March 2020.
IMHO -
Like any medication, side effects of a therapy must be addressed.
If we are going to analyze the metrics of numerator / denominator of all different aspects of treatment, then suicide which has been an "unintended consequence" of the therapies.
For shame you are mocking the mental health aspect - of 4 and unders - we are better than that.
and suicide is up why? what data exist that indicate any causal relationship between COVID vaccination or treatment and suicide? IMHO, your "cure is worse than the disease" warning echoes of all the opposition to social distancing, remote school, and other pandemic mitigation efforts attempted by the health authorities. That, and I would bet large sums of cash that the "increase in suicides" has been mightily assisted by access to guns, so we all might wish to start there (rather than "covid restrictions are killing us") in terms of saving lives.
i can think of a few but go to the US Surgeon General of the USA
QUOTE
“Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.” said Surgeon General Vivek Murthy. “The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating. The future well being of our country depends on how we support and invest in the next generation.
UNQUOTE
NEVER ASSUME Robert... Felix Unger was wise about what happens when someone assumes.
The Surgeon General has lost you that bet -
Wait... data? comparative data? and no, the bet is not lost. The presence of guns in a household is a key predictor of suicide, youth and adult (not even getting into accidental gun deaths or family on family gun activity). BTW, the impact of Covid "run amok" without social distancing (and other public health recommendations /'requirements) would also have been, to use a key word, "devastating"
Robert - you are right and you are mixing apples and oranges.
Guns are probably a key tool used - maybe not predictor but i get the point you are making.
Do not run with the idea that I thought nothing should be done.
We are at a unique time where the risk reward of a policy needs to be considered.
I care about every life but we can not have a zero tolerance for COVID deaths before we start to dial back mitigation tactics.
To think that kids wearing masks all day has no effect except to save lives is irresponsible. Kids are not dying - kids are being affected - dramatically affected.
https://nymag.com/intelligencer/2021/08/the-science-of-masking-kids-at-school-remains-uncertain.html
Please check the Mental Health Crisis kids are experiencing
As a father of two children under the age of 5, I am very sympathetic to how frightening the pandemic can be for parents and how it plays into our core instincts to protect our children (of course, not even mentioning all of the insane disruption it has created in our lives).
I really liked the way you broke down numerator vs. denominator thinking. It's a good label/framework for acknowledging how people are approaching the data from different perspectives and helps us be empathetic to other perspectives.
That said I am a bit disappointed to see numerator thinking validated as equal. Yes, denominator thinking is of little consolation if your kid ends up being in the numerator. However, the inherent flaw with numerator thinking is that it is biased towards whatever you decide to focus on. Not only can numerator thinking logic create fear for pretty much anything where the numerator is > 0, it is not a measure of risk and is also of no use in comparing relative risks and outcomes.
For example, we can look at the number of children hospitalized due to COVID per day and agree that it is a larger numerator than we would like and feel comfortable with. But our bias shows based on what we decide to focus on and pay attention to. It is equally valid to ask - how many children are falling behind in their schooling or social/emotional development? That number is likely millions and a much larger number. That we choose to focus on one numerator and not another is an act of bias.
"Denominator thinking" doesn't eliminate all of that bias, but it does help us analyze the risk involved in a situation and also compare relative risks to each other.
What are the consequences of having a child with a life-long disability? What are the consequences of having a child with a persistent illness for a matter of months or a few years? Phrased more relevantly to the American experience, what are the *costs* of either? Both?
Ah, it depends, doesn't it? It depends on the insurance and it depends on the parents' income.
Funny how the policy makers and leadership are by and large absolved from the pains of scarcity and so can literally afford to ignore numerator thinking. David, could financial security and Cadillac health insurance be your bias in dismissing numerator thinking?
Numerator thinking is absolutely EVERY bit as valid as denominator thinking. The key variance is risk tolerance, which when done correctly focuses on outcomes (thank you, Sidney Dekker). Heaven forbid one of my children end up permanently disabled, I will not be able to afford private care for them when they outlive me. So, no, avoiding COVID like the plague that it is until my infant is vaccinated is pretty key to a successful outcome for my baby.
(Two of my older kids, while with their other parents, caught COVID over the winter holidays--thankfully being fully vaccinated, they had mild cases and no loss of smell, which I am hoping is a reliable proxy for a lack of brain damage.)
I'm sorry to hear about your children catching COVID and I also hope that the mild case is a good proxy for lack of brain damage. I'm not trying to minimize how difficult or awful the situation is, for you or any others, by any means.
You can still use denominator thinking to come to the conclusion that the risks are unacceptably high for you and your family -- denominator thinking is not a proxy for being less safe or cautious. Sometimes it can actually makes us more cautious. What is important is looking at the risks in the context of how likely they are to happen multiplied by how bad the outcome is, and coming to your conclusion based on a risk adjusted analysis.
The example on educational and social/emotional development was perhaps a bit politically charged and so not the best one to use. But we all do risk assessments every day in our lives, when we send our kids to play sports, or jump on a trampoline, or climb a play structure that is a bit advanced for them, or get in a car. The important part is looking not just at the potential outcome but looking at it on a risk adjusted basis.
Thank you for this post. It provides great info for parents still navigating life with an unvaccinated child under 5. Do you have any further info regarding the delay of the Moderna under 5 trial? I actually had not heard anything about this until I read the Slate article you linked at the end of this post! A bit of a gut punch today. Can definitely relate to the author of the article.
Outstanding article. I was never in the military but as a grandpa of 3, the youngest being 2 and a half, I feel like every day is a walk through a minefield of virus bombs. Your explanations give the situation perspective which helps a lot. Thanks!
Are we pretty much dependent on Pfizer for a vaccine for children under 5? I've been following Moderna info too but wondering if there's really any chance of getting a Moderna vaccine for young children first given that they don't have EUA for under 18 yet....
Dr. Jetelina, An advocacy group for expedited vaccines for children under 5 has been created on FaceBook. Would you consider joining or advising on the best advocacy routes at this time? https://www.facebook.com/groups/635645747482854/?ref=share
Thank you for the information, it is very helpful. Do you think the Moderna vaccine will actually be authorized by late March or early April for kids under 5 as stated in this article (https://www.latimes.com/science/story/2021-12-17/whats-the-timeline-for-kids-under-5-to-get-a-covid-vaccine)? In the past I thought we were expecting Pfizer to still be first in the summer.
Thank you for this important information. My son is stuggling with the decision of whether or not to go ahead and get his children, 15 and 13, boosted now, or wait to get the next one that comes out. This is based on his concern that they get the current booster and before enough time has elapsed, there is a new, better one available and they end up unable to get it for a time. What is your thinking on this concept - the current booster now vs. holding out for the next one? The children are in public schools and sports now.