Hospitals throughout the United States are closing pediatric intensive care units (PICUs) and overnight hospital wings for children, leading to a centralization of critical care in major medical hubs. In the past year, units for critically ill children closed in Montana, Oregon, and Missouri, while overnight pediatric wings shuttered in Illinois and California. These closures follow a long-term trend identified by researchers, who found that pediatric inpatient units decreased by nearly 30% between 2008 and 2022.
Health systems and hospital administrators cite several factors for these closures, including low patient volumes, staffing shortages, and financial pressures. Because children require intensive care less frequently than adults, some hospitals report that their units often sit empty. Additionally, the U.S. faces a shortage of pediatric subspecialists, who generally earn less than adult-focused doctors. Hospitals also report higher costs for equipment tailored to children while receiving lower reimbursement rates for pediatric care compared to adult services.
The centralization of care means families in rural or smaller metropolitan areas must often travel significant distances for life-saving treatment. For example, Community Medical Center in Missoula recently closed its PICU after reporting it treated an average of two intensive-care patients per month and could not recruit resident pediatric critical care doctors. The next closest intensive care option for families in that region is located in Kalispell, approximately 150 miles away.
The scale of the decline is significant: the number of hospitals providing pediatric inpatient care fell from 1,749 in 2008 to 1,226 in 2022, leaving three-quarters of U.S. hospitals without such services. Patients and their families may notice longer wait times in emergency rooms—sometimes reaching six hours—and may be stabilized only to be transferred to a different facility rather than being admitted locally. These changes are occurring across various institutions, from small nonprofit community hospitals to large systems owned by private equity firms.
Medical organizations warn that these gaps could widen due to administrative hurdles and changes in federal Medicaid eligibility. Furthermore, the loss of intensive services often leads to a decline in routine pediatric surgeries; for example, the number of hospitals performing pediatric appendectomies decreased by more than half between 2003 and 2022. While medical hubs are being established to manage complex cases, experts like Dr. Kenneth Michelson warn these centers can become overwhelmed during seasonal illness spikes. Future policy discussions are expected to focus on potential solutions such as increasing Medicaid reimbursement rates or securing federal funding to maintain services in low-access areas.