Pediatric Units Closing, Leaving Emergency Rooms Unrepared to Save Critically Ill Children

In 2022, Darby Waldbillig’s nearly two-year-old daughter, Siobhan, woke up swollen and drifting in and out of consciousness. Staff at an emergency room in Helena, Montana, started her on antibiotics and flew her about 100 miles to Missoula’s Community Medical Center. She was diagnosed there with bacterial meningitis. Siobhan survived more than a week in the hospital’s pediatric intensive care unit. Her mother has credited its doctors with saving her life.Last month that unit, the only pediatric intensive care unit in Missoula, stopped taking patients. Community Medical Center, owned by the for-profit Lifepoint Health, said it had not recruited a pediatric critical care doctor to live in the city in eight years. Critically ill children in western Montana will now be stabilized at the hospital, but then sent elsewhere. The nearest suitable facility is in Kalispell, about 150 miles north.Hospitals in Oregon and Missouri have also closed pediatric intensive care units over the last year, and overnight pediatric wings have shut in Illinois and California. In March, Providence Santa Rosa Memorial Hospital in California stopped admitting children to the only full-time inpatient pediatric unit in the 300-plus miles between North Bay and the Oregon border.Each closure puts more pressure on the place most sick children already go first: the emergency room of a general community hospital. More than 80 percent of children who need emergency care in America are treated outside children’s hospitals. Yet only about 17 percent of the country’s emergency departments are rated highly prepared to care for them, a problem doctors have warned about for years, according to a study.Shutting a children’s ward often takes away more than beds, according to a physician who studies emergency care for children.“The biggest change is that a hospital that closes its pediatric inpatient unit often is losing the last pediatrician in the building,” the director of research for the Division of Emergency Medicine at Lurie Children’s Hospital, Kenneth Michelson, tells The New York Sun. “When you close your unit, you lose the child health expert.”So what happens when a child fighting for breath arrives at an emergency room that almost never sees one?Hospitals Can Gain Readiness, and They Can Lose ItThe latest evidence of what that shortfall costs came out in August. A study in JAMA Pediatrics led by emergency physician Craig Newgard at Oregon Health & Science University followed more than 2.4 million children treated at 759 hospitals over a decade, and compared each emergency department readiness scores from 2013 and 2021.Only 13 percent of the departments stayed highly ready in both surveys, according to the study. About 10 percent lost that status, and nearly two-thirds never reached it. The researchers tied the departments that slipped to an estimated 1,727 excess child deaths over the 10 years, and those that never reached high readiness to an estimated 3,776. Hospitals that lost pediatric inpatient services, or never had them, were linked to thousands more.The National Pediatric Readiness Project, a federal effort, scores readiness out of 100 by weighing equipment, staffing, safety rules and quality review. A score of 88 or higher counts as highly ready.What separates the two groups is practice and planning, according to a physician who helps lead the national project.“The real challenge is critical illness or injury in children, which is relatively rare,” a co-lead of the National Pediatric Readiness Project and associate professor of pediatrics and surgery at Dell Medical School at the University of Texas at Austin, Katherine Remick, tells the Sun. “Designating a pediatric champion and engaging in pediatric-specific quality improvement are the most essential steps every ED can take.”Most departments don’t see enough children to stay sharp, another co-lead of the project says.“Based on the published National Assessment of Pediatric Readiness, most emergency departments see relatively few children. Over 80 percent of departments treat fewer than 10 children a day,” a co-lead of the National Pediatric Readiness Project and emeritus professor of clinical emergency medicine and pediatrics at UCLA’s School of Medicine, Marianne Gausche-Hill, tells the Sun.Money is the other obstacle.“Maintaining readiness is both complicated and expensive,” Dr. Michelson continues. “And, most EDs receive no funding to maintain that preparation.”Those rare cases carry outsized danger.Pediatric emergencies are “low frequency but high risk,” a professor of pediatrics at the Medical University of South Carolina, Elizabeth Mack, tells the Sun.Phyllis and Andrew Rabinowitz learned that in 2006, when an emergency room diagnosed their struggling newborn, Rebecca, with a cold and sent her home. She died less than 24 hours later of an enterovirus infection.Following her death, her parents went on to found the R Baby Foundation, to push for better pediatric emergency care.An earlier analysis estimated that 2,143 of the roughly 7,619 children who die each year after reaching an emergency department might have survived if every department hit the 88-point mark, at a national cost of about $207 million a year.Yet reaching the mark once is no guarantee, Dr. Mack warns.“Readiness is not permanent,” she says. “Hospitals can lose readiness when they lose staff, close units, stop maintaining protocols, let equipment expire, etc.”The tax and spending law President Trump signed in July 2025 cuts roughly $1 trillion from Medicaid over a decade and, starting in 2028, caps extra state payments many hospitals rely on to treat low-income children. Another respiratory season is also arriving, months after one of the worst flu seasons in years.“This research reminds us that Pediatric Readiness is an ongoing commitment that requires sustained support, especially as emergency systems face hospital closures, widespread staff turnover and burnout, and challenges with Medicaid reimbursement for pediatric care,” a co-lead of the National Pediatric Readiness Project and professor of pediatrics at the University of Utah School of Medicine, Hilary Hewes, tells the Sun.Two Million Fewer Children Within ReachDistance makes the problem worse. A study in the Journal of Pediatrics found that the share of American children living within a 30-minute drive of a highly ready emergency department fell from 70.2 percent in 2013 to 66.7 percent in 2021, about 2.1 million fewer children.The physician who led that research traces much of the slide to staffing, after many hospitals lost their pediatric emergency care coordinators during the pandemic.“Reports from those on the ground say that the financial and operational stresses of the COVID-19 pandemic often led to these staff being reassigned to other roles,” a pediatric intensivist at Cincinnati Children’s, Allan Joseph, tells the Sun. “The federal government recently conducted another assessment in 2026, so we’ll see whether the stresses of the pandemic were temporary or caused permanent reductions in those staff.”Hospitals have been cutting children’s beds at an even faster clip. A study of hospital data from 2008 to 2022 found that the number of pediatric inpatient units dropped by close to 30 percent. Adult units fell by 4.4 percent over the same years. Hospitals say they don’t treat enough children to keep those units full, and that kids don’t pay well. Medicaid and the Children’s Health Insurance Program cover roughly half of all American children, and both pay hospitals less than private insurance does.When a ward closes, the emergency room loses hands that know children.“In many places, the loss of these units means that there are no longer staff on site who have lots of experience with kids — for example, a nurse who is used to placing IVs in sick babies,” Dr. Joseph says.In February, the first national survey of 911 ambulance agencies gave them a median pediatric readiness score of 65.5 out of 100.New Standards, but No MandateIn January, the American Academy of Pediatrics, the American College of Emergency Physicians, the Emergency Nurses Association and, for the first time, the American College of Surgeons rewrote the national standard, saying it could save more than 2,100 children a year. The update, the first since 2018, covers every emergency department that treats children.It asks every department to name a physician and a nurse as pediatric emergency care coordinators, keep a pediatric resuscitation cart within immediate reach, track pediatric quality measures, coordinate with ambulance crews and screen children for suicide risk and human trafficking.None of the new standards are binding. Hospitals take part in the national assessment voluntarily, though a record number of emergency departments completed this year’s survey. National results have not been released.“Pediatric Readiness needs ongoing maintenance, not a one-time checklist,” Dr. Gausche-Hill says. “The goal should be reliable initial emergency care everywhere, not turning every hospital into a children’s hospital.”Some states have stopped waiting.Utah and Florida passed laws this year requiring every hospital emergency department to name a pediatric emergency care coordinator and complete readiness assessments. The American College of Surgeons now requires the assessments of trauma centers at every level, and on Oct. 9 the federal Emergency Medical Services for Children Program launched a National Pediatric Readiness Coordinating Center.“These efforts are necessary, but they aren’t sufficient to ensure we get top-quality care to all critically ill kids,” Dr. Joseph says.Rules alone will not solve the problem, Dr. Remick cautions.“Emergency care teams are already stretched thin, and requirements work best when they come with real support, training, and standardized resources,” she notes.In other words, ordering a small rural hospital to appoint a pediatric coordinator does little if nobody pays for that person’s time.“I think pediatric readiness should be incentivized and that policy or law could have a major role in it,” Dr. Michelson underscores.That leaves parents with a hard question at 2 a.m., when a child is struggling to breathe, and the closest emergency room is a small community hospital. The doctors interviewed for this story agree on the first step.“First, for a serious emergency, do not delay care looking for the perfect hospital. Call 911 or go to the nearest emergency department,” Dr. Mack says.Planning ahead, however, still helps.“Families should know that most emergency departments can handle most pediatric emergencies,” Dr. Hewes adds. “If you have concerns or your child has specific health needs, talk with your pediatrician or family doctor beforehand about the ED options in your area.”

Pediatric Units Closing, Leaving Emergency Rooms Unrepared to Save Critically Ill Children

Pediatric Units Closing, Leaving Emergency Rooms Unrepared to Save Critically Ill Children

More from the New York Sun

Sri Lankan Spared Execution For Deleted Facebook Post in Saudi Arabia, Remains in Jail

America Pays Twice What Other Rich Nations Do for Health Care. Can Democrats Fix That?

Iran Executed at Least 47 Women in a Year, While Protester ‘Saved’ by Trump Put on Death Row

Trump Officials Credit Cartel Busts for Reducing Overdose Deaths, but Experts Say It’s More Complicated

Ukraine Becomes World’s First ‘Post-Antibiotic War’ as Wounded Fighters Carry Superbugs Home

Democrats, Riding High After Midterm Wins, Will on January 3 Confront Reality of Governing

America’s Great Cities Could Soon Face the Violent Riots Plaguing Paris

‘Some Like It Hot’ and the Art of Near Perfection

More from the New York Sun

Sri Lankan Spared Execution For Deleted Facebook Post in Saudi Arabia, Remains in Jail

America Pays Twice What Other Rich Nations Do for Health Care. Can Democrats Fix That?

Iran Executed at Least 47 Women in a Year, While Protester ‘Saved’ by Trump Put on Death Row

Trump Officials Credit Cartel Busts for Reducing Overdose Deaths, but Experts Say It’s More Complicated

Ukraine Becomes World’s First ‘Post-Antibiotic War’ as Wounded Fighters Carry Superbugs Home

Democrats, Riding High After Midterm Wins, Will on January 3 Confront Reality of Governing

America’s Great Cities Could Soon Face the Violent Riots Plaguing Paris

‘Some Like It Hot’ and the Art of Near Perfection