Methods: Geospatial data from the Children's Hospital Association and the U.S. Census Bureau were utilized to examine the distribution of 217 children's hospitals across 121 Combined Statistical Areas (CBSAs). Children's hospitals were geocoded and buffer analysis was conducted to examine to what extent typical transport radii extend into neighbouring states. Additionally, the proximity analysis was used to determine the average distance of children's hospitals to state lines. Hospitals were clipped to CBSAs to approximate the percentage of the population affected.

Results: Our analysis revealed that 95.4% of children’s hospitals have transport radii that extend beyond their home state boundaries. Particularly, 41.5% of these hospitals are within 20 miles of another state, emphasizing the potential for frequent necessity of interstate interfacility medical transport. Regions such as Montana and Wyoming entirely lack children’s hospitals, illustrating significant geographic disparities in paediatric healthcare access. 36.6% of US population lives in a CBSA that either borders or includes territory in a neighbouring state.

Conclusion: The geographic distribution of children's hospitals necessitates frequent interstate transport, which is complicated by the lack of uniform transport regulations across states. This situation often leads to delays in care and variability in the level of services provided during transports. These findings emphasize the need for federal legislation to facilitate interstate interfacility medical transport and for the establishment of a national paediatric transport registry to ensure consistent, high-quality care and to improve health outcomes nationwide, ensuring all children receive timely and appropriate care regardless of location.