(CNN) With Covid-19 vaccinations on the horizon for children ages 12 to 15 in the United States, pediatricians are concerned about the challenge of getting children up to date on their childhood vaccines, and balancing that with scheduling potential Covid-19 shots.
The US Food and Drug Administration authorized use of Pfizer's coronavirus vaccine in 12-15-year-olds on Monday and scheduled a meeting of its outside advisers for June 10 to discuss the potential use of Covid-19 vaccines in younger children.
"We have seen throughout the pandemic that there has been a decline in routine immunizations, and that does concern me greatly as a pediatrician because I know that many children have missed other important vaccines for diseases like measles or whooping cough -- which, like Covid-19, can be deadly," Dr. Lisa Costello, a pediatrician at West Virginia University Medicine Children's Hospital and a member of the American Academy of Pediatrics' Committee on State Government Affairs, told CNN.
Parents are urged to get their children caught up on immunizations since, Costello said, eventually younger children could soon also be eligible to get vaccinated against Covid-19.
Routine immunizations "fell off a cliff" at pediatrician Dr. Christoph Diasio's practice in Southern Pines, North Carolina, as the pandemic took hold in the US. Diasio told CNN visits for checkups have gone back up at many pediatric practices in recent weeks, but things aren't necessarily back to normal.
"The problem is that because we're behind, you have to go to 130% of normal," Diasio said, adding that his office needs to spread people out physically and budget more time for each visit to maintain pandemic precautions. "Those are good, solid public health measures to prevent contagion at the doctor's office, but they also have the net effect of making it very difficult to catch up on some of these things."
Signs first emerged around the spring of last year that childhood vaccinations have plunged since the pandemic began. One study published in May 2020 by the US Centers for Disease Control and Prevention found that the number of childhood vaccines administered in Michigan dropped by as much as 22%.
The CDC recommends that children get 14 different vaccinations protecting against 19 different pathogens. Timing is important for many of the vaccines to create the strongest immunity.
"It's been documented over the past year that routine childhood immunizations have declined because people weren't going for well-child exams. People were avoiding health settings when not absolutely necessary, and so those rates dipped," Jill Rosenthal, senior program director at the National Academy for State Health Policy, told CNN.
Now, "they're getting back to normal for some populations of kids, and some populations of kids are still a bit behind. So, there's a real concerted effort right now to catch kids up on those routine immunizations, but there's also a blackout period that no one can have other vaccines at the same time that they're getting the Covid-19 vaccine," Rosenthal said.
"So, it's an interesting dilemma of how states and providers are going to think about trying to catch kids up at the same time that the Covid-19 vaccine is becoming available (for children ages 12 to 15) -- and particularly right now because a lot of the catchup routine immunizations happen as a result of school requirements," Rosenthal said. "Summer, maybe early fall, is a time where you see concerted efforts to make sure kids are fully immunized."
The CDC recommends leaving two weeks between other vaccines and getting the Covid-19 vaccine.
"We do not yet know whether we will be able to co-administer vaccines -- meaning you may have to get the Covid-19 vaccine solo, not with other vaccines," Costello said.
The Pfizer/BioNTech Covid-19 vaccine is administered as two doses, three weeks apart.
"Then you have to wait two weeks after that," Costello said. "So, it's really important that parents now are choosing to get their children caught up on other vaccines that they may have had to miss, even if they're under age 12."
When it comes to scheduling Covid-19 vaccinations and catching up on missed immunizations, pediatricians will need to advise patients on a case-by-case basis, Diasio told CNN.
"If I had to pick right now, for certain diseases, I do think Covid is more likely, so I would probably pick the Covid vaccine in a lot of circumstances, but definitely give the patient an appointment to come back in two weeks to get caught up on the other vaccines," he said.
Costello said that she has treated children of various ages for Covid-19 in the hospital -- from a 2-month-old baby having trouble breathing, the infant's small chest slowly expanding up and down -- to a 17-year-old teen needing oxygen support.
Costello hopes that the potential rollout of Covid-19 vaccines for children can help curb the risk of young people getting sick.
"It's going to be important that they are vaccinated -- to help protect themselves, but also to protect their families and their loved ones and their communities," she said.