Childhood and adolescent immunizations compose a valuable public health tool to prevent infection, morbidity, and mortality. The American Academy of Family Physicians recommends that patients receive all recommended immunizations from their usual source of primary care and does not support nonmedical immunization exemptions. Maintaining high vaccination coverage is crucial for preventing outbreaks of vaccine-preventable diseases. Less than 70% of US children have received the full series of recommended vaccinations at 24 months of age. Using electronic health record reminders and creating standing orders to vaccinate according to protocol at every visit can address practice barriers to vaccination. Whereas most routine childhood immunizations have remained the same for the past 10 years, several considerable changes have occurred. With few exceptions, COVID-19 immunizations are recommended annually for all children to prevent disease and hospitalization and to decrease the risk of post–COVID-19 condition. New pneumococcal vaccine formulations that protect against more serotypes are recommended. Pneumococcal vaccination decreases the risk of meningitis, pneumonia, and possibly acute otitis media in children. Either respiratory syncytial virus immunization for the mother between 32 and 36 weeks of gestation from September to January or the monoclonal antibody nirsevimab for the infant from October to March are now recommended for all mother-infant dyads to prevent severe illness.