Respiratory infection surge sounds a wake-up call for pediatric emergency care

“Mommy. Daddy. I can’t breathe.”

Waking up to those words is terrifying for any parent. For me as a pediatric emergency physician, it was especially scary coming from my 8-year-old son while on a trip in rural New York, hours from a specialized pediatric emergency department dedicated to the care of children. As my son approached our bed, I heard stridor, the high-pitched whistling sound that signals an obstructed airway.

With the current surge in respiratory infections among children, parents across the country are going through this same experience. From my work, I know that children have unique medical needs and require specialized care. I also know a child’s risk of dying from a life-threatening acute medical condition increases fourfold when an ED is not pediatric ready, meaning it does not have the “pediatric-specific champions, competencies, policies, equipment, and other resources needed to provide high-quality emergency care for children.”

Children’s hospitals — including Yale New Haven Children’s Hospital, where I work — are designed, staffed, and supplied to take care of critically sick kids, including top-notch emergency care. But many families don’t have access to children’s hospitals. More than 85% of children who need emergency care go to general emergency departments, which concurrently care for children and adults, instead of to specialized pediatric facilities. Research shows that many of those EDs are not pediatric ready or well-prepared to care for children. On a national assessment of pediatric readiness, the median score was 69 out of 100. America’s children deserve care that is better than the equivalent of a D grade.

This is a problem for kids every day. It’s an even greater problem during public health crises like the surge in respiratory illnesses among children, caused by respiratory syncytial virus (RSV), rhinovirus, enterovirus, influenza, all layered atop the Covid-19 pandemic. This surge is pushing the nation’s pediatric capacity to the limit. It’s also exposing and widening cracks in an already strained system. Census data overlaid with emergency department locations show that for a striking 90% of U.S. families, the closest ED to their home is not pediatric ready.

While the issue is making headlines now, it’s not a new one. The U.S. emergency care system was designed for adults. Pediatric emergency cases occur less often than adult ones, making it tempting for health systems to take an adult-centric approach rather than invest in child-specific care. This approach comes with financial incentives: Medical services for children are paid at much lower rates than those for adults.

The result? Inadequate — and vanishing — access to optimal pediatric emergency care are for kids across the country. As the New York Times recently reported, many pediatric-specific units have shrunk or closed. Meanwhile, Covid-19 has decimated the U.S. health care workforce. To those of us in pediatrics and emergency medicine, it is not a surprise, nor the first time, that the country is facing a monumental pediatric-capacity crisis. We have seen increased volumes due to prior RSV and influenza epidemics that exceeded capacity, though this is the first time it has garnered national attention.

According to the Department of Health and Human Services, as of mid-October, more than three-quarters of the country’s pediatric inpatient beds were occupied, with many children’s hospitals, including my own, now exceeding 120% capacity for pediatric intensive care unit beds. In many hospitals children are now being cared for in hallways and transfers from other hospitals may be turned away. This mirrors the surge that the health care system experienced with adults in 2020 due to the Covid-19 pandemic. Pediatric emergency providers and pediatricians have been sounding the alarm for years, but their voices have not been heard.

Two organizations I am involved with — the Emergency Medical Services for Children program (EMSC) and the Pediatric Pandemic Network (PPN) — are working to address gaps in everyday pediatric emergency care and enhance preparedness for surges like the current one. These organizations, funded through HHS’s Health Resources and Services Administration, strive to ensure that children and their families receive high-quality care no matter where they live, what health care systems care for them, and whether their injury or illness is the result of an everyday emergency or a large-scale crisis.

For decades, the EMSC program has focused on developing resources and education to help hospitals and emergency medical service agencies care for kids in everyday emergencies. PPN, a network of children’s hospitals established in 2021, builds on that work, bringing pediatric-readiness principles to disaster and pandemic preparedness. By collaborating with hospitals and health care coalitions on surge-focused resources, PPN is working to improve regional and national capacity to handle influxes of pediatric patients.

The goal of these grant-funded federal programs is to improve emergency care and disaster preparedness for children, but many health care providers and families are not aware of them. Greater awareness and support would be a great investment in the health of U.S. children in every community.

As I listened to my son’s labored breathing this summer, I knew that the nearest emergency department might not be able to provide the life-saving treatment he needed. Fortunately, that ED had worked to ensure its readiness to treat children through a strong collaboration with its regional children’s hospital and state EMSC program. My son received lifesaving X-rays, breathing treatments, and medications in a pediatric-ready community ED, and discharged after treatment and observation in the rural ED. He has made a full recovery.

I hope never again to hear my son gasping for air. But I know that too many parents are in that situation now, seeing their infant or child sick struggle to breathe and facing long wait times at best or, at worst, care that doesn’t fully meet their needs.

Providing children with the best emergency care possible shouldn’t take a wake-up call like the capacity crisis caused by the current surge in respiratory infections. Children and their families deserve better. Without immediate action, I worry that children’s lives will be needlessly lost due to a lack of access to timely emergency care and intensive care unit bed capacity.

Marc Auerbach is a pediatric emergency physician at Yale New Haven Children’s Hospital, and the director of pediatric simulation and a professor of pediatrics and emergency medicine at Yale University School of Medicine. He serves on the leadership teams of both the Emergency Medical Services for Children Innovation and Improvement Center and the Pediatric Pandemic Network.