Fewer Hospitals Providing Pediatric Services, Study Shows

The number of U.S. hospitals equipped to provide medical care for children and adolescents declined significantly between 2003-2022, according to a study published in the January 2026 Pediatrics. The study, “Pediatric Capabilities in US Hospitals: 2003-2022,” used data provided by the Healthcare Cost and Utilization Project Kids’ Inpatient Database to review a mean 3,927 hospitals per year, including non-profit, urban teaching and small institutions. The number of low-capability hospitals –defined as providing virtually no pediatric services outside of the emergency department or obstetrical unit --more than doubled over two decades. Over the same time, hospitals offering higher levels of pediatric capability declined substantially, according to the study. The authors grouped hospitals as Level 1, Level 2, Level 3 and Level 4, with Level 1 hospitals capable of providing many advanced pediatric services. Level 2 and 3 provide moderate-intensity pediatric services, and Level 4 provides few to no pediatric services. Over the study timeframe, numbers of Level 1 hospitals decreased 38%; Level 2 hospitals decreased 54%; Level 3 hospitals decreased 48%; and Level 4 hospitals increased 137%. The steepest declines of hospital-level specific services were for moderate-intensity services including appendectomy, pneumonia hospitalization and asthma hospitalization. The authors suggest several reasons why hospitals have retreated from providing pediatric care, including lower reimbursement levels compared to adults and a shortage of pediatric care providers. Many children are on Medicaid, which provides lower reimbursement rates compared to private insurance and Medicare. These factors have limited national capacity to provide pediatric hospital care across a range of conditions and complexity.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.