Can the local ER handle your child’s emergency?

According to a new study, emergency rooms across the United States fail to reliably treat one major population—children. 

For years, research has shown that the quality of pediatric care in U.S. emergency departments varies widely from hospital to hospital and state to state. Today, most children in a health crisis still end up in emergency rooms that have limited exposure to pediatric patients. Many do not have the equipment to treat them.

Last month, a new study analyzing millions of emergency room records concluded improving pediatric emergency care could save more young lives and wouldn’t cost much.

The findings, which were published in the October issue of the journal Health Affairs, analyzed the records of 7.9 million children admitted with acute illnesses or life-threatening injuries in 11 states between 2013 and 2021. The researchers developed a model that examined two hypothetical scenarios—one, how would children fare under the current state of readiness? And two, how would they fare if all emergency rooms in those states were fully prepared to treat kids?

If hospitals were at high readiness, the study estimated child mortality would decrease, from 78 children out of 100,000 to about 33 children out of 100,000. The study also noted that quality of life would improve for all children treated. Getting an emergency room to high preparedness would cost an estimated $8 million per 100,000 children, according to the analysis. That comes out to $80 per child. A November study estimated the cost to improve emergency pediatric readiness could be anywhere from zero to under $12 per child.

The latest findings add to mounting concerns that emergency departments are not doing enough for their youngest patients. According to the National Pediatric Readiness Project, the majority of children treated for emergencies end up in hospitals that see fewer than 15 pediatric patients a day. A 2023 Wall Street Journal investigation noted that only 14 percent of emergency departments are prepared for child emergencies.

Every expert I spoke to said it’s easy to understand why so many hospitals are ill-equipped to treat kids. “They understandably tend to prioritize the patients they see most: adults,” said Dr. Kate Remick, executive director of the National Pediatric Readiness Quality Initiative and an associate professor of pediatrics and surgery at the University of Texas at Austin.

Even so, Remick and others said the benefits to children outweigh the costs of the improvements.

“Unfortunately, around 1,400 kids per year are passing away from lack of pediatric emergency care, and people aren’t really aware of this,” said Phyllis Rabinowitz, founder of R Baby Foundation, a nonprofit dedicated to improving emergency care for children. “Every child should be able to be diagnosed correctly, treated correctly, or at least have the health care in place to be stabilized and transported.”

Rabinowitz speaks from experience. In 2006, Rabinowitz took her one-week-old baby girl to the emergency room. Baby Rebecca was lethargic, struggled to feed, and had congestion that Rabinowitz said sounded like “an 80-year-old man with asthma.” Doctors believed she had cold symptoms and sent the family home. Rebecca died days later. An autopsy revealed that the newborn had an enterovirus infection—something Rabinowitz says the hospital ER doctors missed. She founded R Baby a year later.

I asked her and others what a well-equipped pediatric emergency room would look like. The first step is hiring a pediatric emergency care coordinator, commonly called a PECC. This person—usually a trained nurse—would procure children’s medical equipment and make sure emergency staff are trained to support young patients, and their parents.

Natasha Kurth, executive director for the nonprofit Children’s Emergency Care Alliance of Tennessee, said children’s bodies and needs are uniquely different, so caring for them should look different.

“Children tend to have smaller airways,” Kurth said. “Their body temperatures can fluctuate a lot more rapidly than an adult can. Their body metabolizes medications differently than adults. They’re not able to articulate their symptoms the way adults can describe things.”

Doctors may need smaller intubation tubes to fit smaller airways and syringes sized for smaller veins. Wiggly babies who can’t sit up need to be measured on infant scales that “freeze-frame” the infant’s weight in both pounds and kilograms so doctors won’t need to do tricky conversions for medication dosages.

“If you’re having to stock all of these sizes and their expiration dates on all of these supplies, and you’re only seeing 10 pediatric patients a day, or 10 pediatric patients a week, then it’s for some hospitals perceived as being cost-prohibitive,” said Dr. Ashley Saucier, a New Orleans pediatrician who’s also certified in pediatric emergency medicine.

In many areas, though, the trouble isn’t just convincing hospitals of the need, but finding enough trained staff and keeping them gainfully employed.

Saucier adds that pediatric emergency medicine is a relatively new specialty, so finding doctors trained in it are rare. “There are more registered NFL players in the country than board certified pediatric emergency medicine physicians,” she said.

Right now, these sorts of hospital improvements are voluntary. But Rabinowitz says her organization has its sights set on making them mandatory. Recently, R Baby Foundation announced a partnership with a Washington, D.C-based advocacy group in the hopes of writing pediatric emergency readiness into federal law.

Remick at the National Pediatric Readiness Quality Initiative says that, in the end, emergency rooms should be ready for everyone, whether adults or children.

“Children are too precious and too vulnerable for us to not be prepared when they need us most,” she wrote in an email.