Study Identifies Inadequacies in Defining Strain on Children’s Hospitals

Children’s hospitals are under increasing strain to provide pediatric inpatient care as general hospitals have reduced pediatric services over the past 15 years, and care is increasingly concentrated into these settings. A study, “Capacity Strain in U.S. Children’s Hospitals: A Mixed-Methods Study of Measurement and Mitigation,” examines the ways hospitals measure the strain on services and staff and finds that current methods do not adequately capture key elements contributing to the strain. The study, published in the July 2026 Pediatrics (prepublished online April 24) defines strain as demand approaching or exceeding a system’s ability to deliver timely, high-quality care.  Authors received responses from 45 operationally independent children’s hospitals and interviewed 20 leaders; 43 hospitals reported experiencing capacity strain within the last 12 months. Most hospitals lacked full alignment between metrics identified as important indicators of strain and those used to trigger mitigation. Early strategies included encouraging discharges, activating staff, and opening additional bedspace, whereas diversion or procedure cancellations were implemented later despite being perceived as relatively more effective. Leaders described a challenging environment with a complex array of competing priorities as they try to provide access for children who need it. The authors suggest that improving strain management will likely require coordinated changes across multiple levels of the system, including re-envisioning measurement tools to better capture strain and broader health care policy to address the constraints driving this pressure.

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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.