During the past decade, hospitals of all sizes have closed or downsized pediatric inpatient units and decreased pediatric beds, often citing financial pressures, staffing shortages, and a growing demand for adult beds.
A national analysis of pediatric inpatient capacity found that, from 2008 to 2018, pediatric inpatient units decreased by 19.1%, with rural communities seeing the steepest declines and nearly one-quarter of children now living farther from their nearest pediatric unit.
1 Another study found that, between 2008 and 2022, U.S. hospitals closed nearly 30% of pediatric inpatient units, while adult inpatient units declined by only about 4%.
2 This trend means fewer local beds for children, more transfers to regional centers, and longer distances and delays for families seeking care.
The Society of Critical Care Medicine (SCCM) is collaborating with its members and the medical community and exploring training solutions. To guide this work, SCCM is asking clinicians to share their stories to elevate the experiences of critical care clinicians caring for children and pregnant or postpartum patients in an increasingly fragile system.
Please share your experience if your institution has:
- Closed or downsized a pediatric inpatient unit, PICU, or maternity/birthing unit, or
- Changed how and where you transfer pediatric or obstetric patients, or
- Faced new challenges in stabilizing these patients in the ED or ICU, or
- Experienced an increase in number of patients due to closures in your area
Share Your Story
Your responses will help SCCM identify gaps in support for hospitals caring for these vulnerable children, shape future educational offerings, and inform discussions with SCCM leadership and partner organizations, including potential advocacy and research initiatives.
How SCCM Is Responding
Collaborating With the Broader Medical Community
In partnership with the American Academy of Pediatrics, SCCM delegates to the American Medical Association (AMA) passed a resolution requesting that the AMA formally recognize these closures, including pediatric hospitals and general pediatric units, as a critical threat to children's healthcare access and quality.
This resolution established the AMA’s commitment to collaborate with other key stakeholders to:
- Improve access to care
- Address health disparities arising from these closures
- Increase public awareness of this issue
- Develop comprehensive strategies for preserving access to high-quality pediatric emergency, inpatient, and critical care services
Exploring Regional and System-Based Solutions
Through programs such as Fundamental Critical Care Support (FCCS): Pediatrics and FCCS: Obstetrics, SCCM provides training to help clinicians recognize, stabilize, and safely transfer critically ill children and pregnant and postpartum patients, even in hospitals without dedicated pediatric or obstetrics units.
SCCM is assessing how it can support hub-and-spoke training models, in which larger children’s hospitals and perinatal centers host education for teams from referring hospitals, helping to build shared protocols and competency across an entire region. SCCM is also exploring how to bring training directly to resource-limited areas, especially hospitals and regions most impacted by closures.
Thank you for everything you do to care for critically ill and injured patients, especially children and pregnant or postpartum patients, during a time of profound change in how and where hospital services are delivered. SCCM is committed to learning from your experience and working with you to find practical pathways to support the patients and communities who rely on you.
References
- Cushing AM, Bucholz EM, Chien AT, Rauch DA, Michelson KA. Availability of pediatric inpatient services in the United States. Pediatrics. 2021 Jul;148(1):e2020041723.
- Michelson KA, Cushing AM, Bucholz EM. National trends in pediatric inpatient capacity. JAMA Pediatr. 2025 Feb 1;179(2):208-209.
