Throughout the pandemic, millions of Americans relied heavily on pharmacies for easy access to COVID-19 vaccines and boosters.

According to the Centers for Disease Control and Prevention, retail pharmacies across the country have administered and reported more than 254 million doses of COVID-19 vaccine as of June 8.

However, parents hoping to vaccinate their toddlers and babies following last week’s approval of COVID-19 vaccines for children under the age of five may be in for a surprise. According to a 2021 map created by the National Alliance of State Pharmacy Associations, most states do not allow pharmacists or their technicians to administer vaccines to children under a certain age.

“It’s been a process for the past 30 years to get pharmacists immunization administration authority,” said Allie Jo Shipman, the pharmacy association’s director of state policy. “It varies by state, and a lot of it is political.”

Many states in the Northeast prohibit pharmacists from administering vaccines to children under the age of 18, with the minimum age set at 18. Age restrictions in other states range from 6 to 14.

The federal Public Readiness and Emergency Preparedness Act of June 2021 modified these age restrictions, allowing pharmacists to temporarily order and administer vaccines to children over the age of three during a public health emergency.

However, a sizable number of children who are eligible for a COVID-19 shot will be unable to obtain one at their local pharmacy, including some of the country’s largest chains.

According to a message on the Walgreens website, patients must be 3 years old or older to receive the COVID-19 vaccine.

According to company spokesperson Matthew Blanchette, CVS pharmacists offer vaccinations to children aged 5 and up in select locations. Parents with younger children are directed to the MinuteClinic website, where board-certified family nurse practitioners, physician assistants, and nurses are authorized to vaccinate children under the age of five.

Although COVID-19 vaccines are approved for infants 6 months and older, the MinuteClinic will vaccinate children as young as 18 months.

“We recommend reaching out to your child’s pediatrician for vaccination options for children ages six to 17 months,” Blanchette said in a statement sent to USA TODAY on Wednesday.

While some states have no restrictions on pediatric vaccines, Shipman says many pharmacists refuse to vaccinate small children.

“Even though pharmacists have been trained to do it, they don’t feel comfortable because they haven’t had much practice or haven’t immunized children in that age range since they were trained,” she explained.

She recommends that parents call ahead of time before scheduling a COVID-19 vaccine appointment to ensure that their pharmacist is willing to administer the shot.

Vaccinating infants and toddlers requires “a higher level of skill and experience” than adults, according to Dr. Robert Amler, dean of New York Medical College’s School of Health Sciences and Practice.

He claims that because the overall target is smaller, medical professionals must use a shorter needle. Instead of the shoulder, shots are administered to the leg, avoiding certain muscles “to avoid serious injury.”

“Calming and handling an anxious baby and parent requires an advanced skill set that is developed through experience,” Amler said. “Medical personnel who care for patients in this age group on a regular basis are aware of these issues.”

While providing vaccines during one-on-one pediatrician appointments is ideal, some families, particularly in poorer communities, lack a “medical home,” according to pediatrician Dr. Sara Bode, medical director of Nationwide Children’s Hospital’s school-based health and mobile clinics program in Columbus, Ohio.

She believes that leveraging relationships with trusted neighborhood centers, such as day cares or preschools, where the hospital already sends mobile medical units for other health services, will be critical to vaccinating younger children of color and others in marginalized communities.

“We already have several of our early childhood education centers that serve kids who are either economically disadvantaged or have a higher percentage of kids who are racial and ethnic minorities,” Bode said. “We have to think about having clinics that are at locations that are easily accessible.”