观点：美国儿童急诊医疗已陷入永久危机状态

By Jonathan E. Kohler and Mary A. King

Oct. 27, 2026

Kohler is a pediatric surgeon in Sacramento, Calif. King is a pediatric intensivist in Seattle.

In the winter of 2022, two parents carried their sick, coughing baby boy into an emergency room deep in California’s Sierra Nevada mountains. The small rural hospital had no pediatric specialists, no pediatric nurses, and no children’s intensive care unit. But it was hours closer than any hospital that did.

The doctor at that rural hospital recognized immediately that the baby’s condition was beyond their capacity to treat. They called regional children’s hospitals like ours for help. But the winter of 2022 was the peak of the “tripledemic” — Covid, influenza, and RSV striking children simultaneously — and every children’s hospital in northern California was overwhelmed. None of us had room for one more.

There was no single call the team at that hospital could make to locate a pediatric ICU bed. They worked a phone tree, hospital by hospital, asking for an opening. Meanwhile, the baby’s condition worsened. As the team tried to insert an infant-sized breathing tube, the baby died.

That patient’s death and others like it were galvanizing for those of us in on the other end of those desperate calls for help. Saying no to our colleagues and the patients they’re caring for feels horrible.

But the extraordinary crush of the tripledemic has continued. In 2026, the unprecedented pediatric patient crowding of 2022 has become a normal Tuesday.

In this new normal, community hospitals across the country are transferring children to dedicated pediatric centers not just because a child is critically ill, but increasingly because smaller hospitals have quietly lost the ability to manage even common conditions. A 1-year-old with an allergic reaction, a 6-year-old with an asthma attack, a teenager with gallstones — community hospitals once handled these patients locally. Now, as they degrade or eliminate pediatric care, that local safety net is disappearing. The nation’s relatively few children’s hospitals can’t accommodate every sick child, much as we would like to. We now routinely turn sick children away and hope one of our colleagues somewhere else will have a bed.

There is another story from that same winter of 2022. Two parents brought their sick baby girl to a small rural hospital in Washington state’s Northern Cascades. For 12 hours, doctors there tried to find a hospital that could take her. Again, no children’s hospitals had room.

Finally, the emergency physician called Washington’s Regional Medical Operations Coordination Center, or RMOCC — a kind of air traffic control for patient transfers that can match critically ill patients to available beds across a region. The RMOCC pediatrician who answered later recalled the terror in the calling doctor’s voice: “Don’t you know I feel like I am having a heart attack every moment I am caring for this tiny baby? It has been 12 hours. I am terrified she will die here. Why can’t anyone help?”

The RMOCC found a hospital willing to make an exception to its infection-control policies and accept the baby into a neonatal ICU. Unlike the California baby, she lived.

The Washington RMOCC closed last year after budget cuts. It is seeking renewed funding in this year’s budget.

There are many reasons for the collapse of pediatric capacity. Most are fundamentally financial. Hospital bottom lines require high reimbursement, high volume procedures, and expensive, complex treatments. Children’s care often reimburses below the cost of care, meaning that pediatric admissions for common childhood diseases lose money. Hospitals are incentivized to abandon pediatric care in favor of complex adult surgical programs and cancer treatments.

There are three changes in health care policy that could save and restore regional pediatric capacity.

First, Medicaid payments for pediatric care need to reflect the costs of that care. Hospitals can’t be asked to lose money on pediatric admissions and ED visits. Unfortunately, coming cuts to Medicaid seem likely to make reimbursement for children’s care worse rather than better. The incoming Congress must act to preserve and augment funding for pediatric care.

Second, regional RMOCCs like Washington state’s should be a standard part of regional disaster planning and a state and national funding priority. At least 19 states had regional or statewide MOCCs in 2023, though many were open only during surges, and some, like Washington’s, wound down with the end of the pandemic. When a sick child arrives at a rural emergency department, the hospital shouldn’t have to resort to a phone tree to find an accepting specialty facility. A single phone call to a regional air traffic control system for patient movement saves time and lives.

Finally, children’s hospitals need support to be regional resources to the smaller hospitals that depend on them for advanced pediatric care. Incentives for providing telehealth consultations, training, and quality improvement support for community hospitals are essential, as children’s hospitals face the same fiscal realities as their rural peers and cannot provide infinite unfunded support to their communities. Remote support from pediatric specialists can reduce the need for transfers and make local care safer, which could drive down pediatric care costs in the long term.

In pediatric medicine, we like to say that “children are not little adults.” Unfortunately, they are also not what health care executives call “priority populations.”

But children deserve to have quality care available in their own communities. They shouldn’t have to spend hours in waiting rooms and hallways awaiting transfer to overwhelmed regional centers. As pediatric physicians, we’ve gone from seeing the crisis coming to living the crisis every day. So far that crisis has been mostly hidden within the walls of our hospitals, but it’s time everyone know: Our children are out of room.

Jonathan E. Kohler, M.D., is a pediatric surgeon in Sacramento, Calif. Mary A. King, M.D., M.P.H., is a pediatric intensivist in Seattle.