Hospitals Shut Pediatric ICUs in Montana, Oregon and Missouri in the Past Year, Citing Low Volume and Cost

Hospital units built for the sickest children are closing across the country.

In the past year, hospitals shut pediatric intensive care units in Montana, Oregon and Missouri. Overnight pediatric wings also closed in Illinois and California. Pediatric ICUs are separate from neonatal intensive care units, and depending on the hospital they can treat patients from a few weeks old into their teens or early adulthood.

The numbers behind the closures

The trend is not new. An analysis of pediatric inpatient units found they fell by nearly 30% between 2008 and 2022, from 1,749 hospitals to 1,226. That analysis found three-quarters of hospitals with no pediatric inpatient services at all.

Many hospitals are converting freed-up beds into services for newborns or adults. The result is that pediatric intensive care is concentrating in large medical hubs. Critically ill kids have to travel farther to reach one.

"You can't expect that people will be fine if the next-closest children's hospital is a flight away or an eight-hour drive," said Elizabeth Mack, a pediatric critical care doctor and spokesperson for the American Academy of Pediatrics.

Why hospitals say they are cutting

The hospitals' own explanation is arithmetic. Few children need intensive care, so the units sit underused. The country is short on pediatric subspecialists, who earn less than doctors focused on adults. Hospitals are often paid less to treat children than adults, and gear sized for kids adds cost.

Mack, who also consults for hospitals on patient quality, calls cutting kids' services a "spreadsheet issue." She added: "This is a very pricey endeavor, and it's not sustainable. There's not a great answer here."

The cutbacks are not limited to one type of owner. They are happening at community hospitals run by small nonprofits and at those owned by large private equity companies. Rural areas feel it most.

Medicaid adds pressure

About half of American children are covered by Medicaid or the related Children's Health Insurance Program. Medical researchers and organizations warn the gaps will widen because of cuts in federal Medicaid spending.

The Trump administration has added administrative hurdles to the program and narrowed who qualifies. Those changes target adults. But public aid researchers say that when caretakers get tangled in paperwork, children can lose coverage too.

Fewer people on Medicaid, adults or kids, means a financial hit for hospitals that are already weighing which services to keep.

Crowding at the big centers

Two physicians who work at the receiving end of these transfers describe a system that is already stretched. Jonathan Kohler, a pediatric surgeon in Sacramento, and Mary King, a pediatric intensivist in Seattle, wrote in a STAT opinion piece that the crowding seen during the 2022 "tripledemic" of Covid, flu and RSV has become routine. "In 2026, the unprecedented pediatric patient crowding of 2022 has become a normal Tuesday," they wrote.

They describe a baby boy brought to a small rural hospital in California's Sierra Nevada in the winter of 2022. The hospital had no pediatric specialists, pediatric nurses or children's ICU. Staff phoned regional children's hospitals one by one and found no open bed. The baby died as the team tried to insert an infant-sized breathing tube.

Kohler and King say community hospitals are now transferring children not only for critical illness but because smaller hospitals have lost the ability to manage common conditions. Their examples include a 1-year-old with an allergic reaction, a 6-year-old with an asthma attack and a teenager with gallstones. Children's hospitals, they write, "now routinely turn sick children away" and hope a colleague elsewhere has room.

One model for coordination

The same op-ed points to a Washington state system as a partial answer. A different baby that winter waited 12 hours at a small Northern Cascades hospital while doctors searched for a bed. The emergency physician finally called Washington's Regional Medical Operations Coordination Center, known as RMOCC. Kohler and King call it "a kind of air traffic control" that can match critically ill patients to open beds across a region.

A coordination hub moves patients around. It does not add beds. Closing units, whether for staffing, volume or reimbursement reasons, shrinks the pool that any such system can draw on.

It is unresolved who covers the cost of keeping low-volume, high-expense units open in places with few children and fewer specialists. Hospitals say they cannot. Nothing in the current closures shows who will.