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The updated 2023–24 COVID-19 vaccine was available in the United States beginning September 2023. Our objective was to identify reasons for decisions related to vaccination of children in the household. In December 2023, adults in Oregon and Washington were asked whether they or their household children had received the 2023–24 COVID-19 vaccination. Adults with unvaccinated children were asked about intentions to vaccinate and to rank the top three reasons for their decision. Vaccine concordance between adults and household children was assessed. Among 1067 adult participants, 33 % (n = 352) of adults reported at least one unvaccinated household child: 23 % intended to vaccinate and 10 % did not intend to vaccinate. Among 243 adults who intended to vaccinate, 73 % selected “if there is more severe illness in my school or community”, as a primary reason; the highest ranked reason among those not intending to vaccinate was the belief that their child would not become severely ill (66 %). 78 % of adults made the same vaccine decisions for themselves and their children. Participant's perception of their child's individual risk from SARS-CoV-2 infection was the primary consideration impacting vaccine uptake and intent for 2023–24 COVID-19 vaccine.