How available is pediatric inpatient care?

The regionalizing of pediatric care and a decline in pediatric hospitalizations has led to shifts in pediatric inpatient care. A report looks at the current inpatient care trends.

Over the past several years, access to pediatric care has shifted and families may find themselves living in an area with a lack of pediatric inpatient units. A report in Pediatrics examines the trends in both pediatric inpatient unit capacity and access, as well as a look at what units are risk of closure.1

The investigators used the 2008-2018 American Hospital Association survey to do a retrospective study of 4720 hospitals in the United States. They compared by state the trends in pediatric inpatient days and bed counts. Changes in access to care were measured by calculating the distance to the nearest pediatric inpatient services by census block group. Trends in pediatric inpatient unit and pediatric intensive care unit capacity were described using linear regression.

They found that during the studied time that pediatric inpatient units decreased by (34 units per year; 95% CI 31 to 37) as well as a decrease of 11.8% in the number of pediatric inpatient unit beds (407 beds per year; 95% CI 347 to 468). There was an increase in pediatric intensive care unit beds of 16.0% (66.9 beds per year; 95% CI 53 to 81), but this increase was mostly seen in children’s hospitals rather than general hospitals. Most states in the country saw decreases in pediatric inpatient days (median state −10.0%) and pediatric inpatient unit beds (median state −18.5%). Unsurprisingly, rural areas saw steeper declines in pediatric inpatient unit beds than nonrural areas (−26.1% vs −10.0%). Roughly 25% of all children in the United States saw a distance increase to the nearest pediatric inpatient unit. The highest risk of closing was noted for units that had low volume as well as those that did not have an associated pediatric intensive care unit.

The investigators concluded that overall pediatric inpatient unit capacity is declining across the United States. Access to this care is becoming increasingly unavailable to an increasing number of children, many in rural areas who already face care access issues.


1. Cushing A, Bucholz E, Chien A, Rauch D, Michelson K. Availability of pediatric inpatient services in the United States. Pediatrics. June 14, 2021. Epub ahead of print. doi:10.1542/peds.2020-041723