The "Standards for Pediatric Immunization Practices," recommended by the National Vaccine Advisory Committee and approved by the US Public Health Service, provides guidance to clinicians as to what the National Vaccine Advisory Committee considers optimal practice. Each of the 18 recommendations reflects the ideal; unfortunately, life in the trenches is less than ideal. Providers must reflect on each point and consider how they might modify their own practices to help us to realize the goal of Healthy People 2000, that is, 90% immunization coverage by the child's second birthday. The Standards are clear. They are reprinted herein from MMWR (April 23, 1993;42[5]). Following each is a response, sort of a reality check, from the author, a practicing clinician and practice administrator.