Hospital units dedicated to treating the nation’s sickest children are disappearing across the country. In the past year, hospitals have closed pediatric intensive care units in Montana, Oregon, and Missouri. Overnight pediatric hospital wings have also shut down in Illinois and California.
A shrinking safety net
Pediatric units, distinct from neonatal intensive care units, serve patients from a few weeks old to teens or early adults. As hospitals aim to reduce costs, many are converting these beds into services for newborns or adults. Consequently, pediatric intensive care has become centralized in medical hubs, forcing critically ill children to travel farther for lifesaving treatment.
“You can’t expect that people will be fine if the next-closest children’s hospital is a flight away or an eight-hour drive,” said Elizabeth Mack, a pediatric critical care doctor and spokesperson for the American Academy of Pediatrics.
Hospitals often cite low patient volumes as a reason for cutting pediatric care, as it’s uncommon for children to need intensive care. Additionally, there’s a shortage of pediatric subspecialists, who earn less than adult-focused doctors. Hospitals also receive lower payments for treating children and face extra costs for kid-specific equipment.
The gap in care is particularly severe in rural areas. Cutbacks are occurring across community hospitals, whether owned by small nonprofits or large private equity firms. An analysis of pediatric inpatient units found a nearly 30% decrease from 2008 to 2022, dropping from 1,749 hospitals to 1,226. This leaves three-quarters of hospitals without pediatric inpatient services.
Medical researchers and organizations warn that these gaps will worsen due to cuts in federal Medicaid spending. The Trump administration introduced administrative barriers and stricter eligibility criteria for Medicaid, primarily targeting adults. However, about half of the nation’s children are covered by Medicaid or the Children’s Health Insurance Program. Public aid researchers note that when caregivers struggle with paperwork, children can lose coverage.
Mack, who also works as a hospital consultant on patient quality, described cutting kids’ services as “a spreadsheet issue” for most hospitals. “This is a very pricey endeavor, and it’s not sustainable,” she said. “There’s not a great answer here.”
In 2022, when Darby Waldbillig’s toddler struggled to wake up, the closest pediatric critical care option was in Missoula, Montana—a 100-mile emergency flight from their home in Helena, the state capital.
“Her face was swollen. She was drifting in and out of consciousness,” Waldbillig recalled.
Her nearly 2-year-old daughter, Siobhan, had bacterial meningitis, a life-threatening infection causing brain and spinal cord swelling. Local emergency workers started antibiotics before transferring her to Missoula’s Community Medical Center, where Siobhan spent over a week in the pediatric intensive care unit—the same unit that closed this month.
“I firmly believe it’s because of those doctors that she lived,” Waldbillig said.
Impact on Families and Communities
Greg Cook, the hospital’s CEO, emphasized that most children will still receive treatment locally. However, those needing intensive care, such as ventilator support or continuous seizure monitoring, will be sent to other facilities. Cook stated the decision prioritizes quality care over financial concerns.
Factors Behind Pediatric Unit Closures
Hospitals closing pediatric intensive care units often point to low patient numbers and staffing challenges. In Missoula, the unit saw about two children monthly needing intensive care before its closure. The hospital struggled to recruit local pediatric critical care doctors for eight years, relying on specialists flying in.
Community Medical Center, owned by for-profit Lifepoint Health, consulted with its parent company before downgrading the unit. Similarly, St. Vincent Medical Center in Portland, Oregon, part of the nonprofit Providence health system, cited low patient volume as the primary reason for closing its unit, despite financial shortfalls.
Broader Implications and Potential Solutions
Raj Basu, division chief of critical care medicine at Lurie Children’s Hospital, warned that treating complex cases without adequate expertise could endanger patients. He noted that while medical advancements have reduced hospitalizations, surviving children often have more complicated conditions requiring specialized care.
Medical organizations are exploring solutions, such as regional training programs and protocols for patient transfers.
