Regionalization of pediatric services has created geographic gaps in access to care.


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Hospital closures and consolidations in the United States over the last decade have resulted in a sharp decline in the number of pediatric beds, especially in rural areas and smaller communities, requiring some families to travel further to obtain inpatient care for their sick children.

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A retrospective study in the July 2021 Pediatrics of 4,720 general and pediatric hospitals looked at trends in pediatric inpatient units from 2008 to 2018. The analysis showed a 19.1% decline in the number of dedicated hospital pediatric units and an 11.8% overall loss of pediatric beds during this period, resulting in a quarter of children in the United States now having to travel further for acute care.


Rural areas experienced a disproportionate share of these losses. At the same time, the overall number of pediatric ICU beds increased by 16%, mainly in urban children's hospitals. These shifts in the number and geographical location of pediatric beds are due, in part, to a downward trend in hospitalizations for children with acute illness as well as regional consolidation of services for children with complex medical conditions. Nevertheless, the loss of capacity at the community level has raised questions about the health care system's readiness to respond to children's medical needs during times of increased demand.


Commentators cite the recent surge in cases of respiratory syncytial virus, or RSV, which put pediatric practitioners, hospital administrators, and many parents into "crisis mode," according to one analysis. In some cases, a lack of local beds necessitated the transfer of young patients to distant cities and even out of state. Another example is the COVID-19 pandemic, which significantly curtailed children's access to services when some hospitals converted pediatric beds in order to care for the overflow of adults with SARS-CoV-2.


Compounding the problem is a shortage of qualified pediatric staff-physicians, nurses, and respiratory therapists-which further limits capacity at hospitals still accepting pediatric patients.


Pediatric clinicians are trained to incorporate the nuances of growth and development in children and their pathophysiology into treatment regimens. Pediatric nurses, in particular, are expert in spotting subtle signs of a child's worsening condition-for example, breathing difficulty-and assembling the health care team needed for rapid response. "Pediatric nurses are not a commodity, we are a necessity," said Kristi Westphaln, assistant professor in the UCLA School of Nursing, and pediatric NP at Children's Hospital Los Angeles.


With the closure of pediatric units at local hospitals, Westphaln said sick children brought to the ED by their families may not be treated by clinicians who are well versed in pediatric care, potentially putting the patients at risk. Facilities without dedicated pediatric units may also lack proper-sized equipment for an IV start, intubation, or suctioning, and staff may not be sufficiently trained in specialized aspects of pediatric care such as medication dosing, which in children is by weight in kilograms, not by age, Westphaln said.-Liz Seegert