Pediatric chronic pain is far more than a persistent symptom. It drives functional impairment, school absenteeism, and psychological comorbidity, and managing it typically requires simultaneous input from primary care clinicians, subspecialty physicians, physical therapists, and behavioral health providers. When these systems fail to communicate, ambulatory management becomes fragmented, and families often turn to emergency departments for acute crisis stabilization. Yet emergency departments are fundamentally ill-equipped for longitudinal, rehabilitative pain care, exposing children to episodic and uncoordinated interventions while imposing avoidable costs on families and health systems.

The research team, led by investigators at Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine and collaborating institutions, analyzed the 2022 through 2024 editions of the National Survey of Children’s Health, a nationally representative survey administered by the US Census Bureau on behalf of the Health Resources and Services Administration’s Maternal and Child Health Bureau. From an initial pooled sample of 160,640 respondents, the researchers restricted the cohort to children aged 6 to 17 years whose caregivers reported chronic physical pain and an identified need for care coordination, yielding an unweighted analytic cohort of 6,326 children representing an average of 878,491 children annually.

The exposure was straightforward: caregivers who affirmed that their child needed help arranging or coordinating care among two or more doctors, specialists, or service providers were divided into those who received all needed coordination and those who did not. The primary outcome was any all-cause emergency department visit in the prior 12 months, with recurrent visits of two or more encounters analyzed as a pre-specified sensitivity outcome. Secondary access outcomes included any unmet healthcare need and forgone needed mental health care over the same recall window.

The baseline clinical profiles of the two groups differed in ways that mattered for the analysis. Children with unmet coordination needs carried a higher observed burden of vulnerability: only 48.1 percent had adequate insurance compared with 68.5 percent of children who received coordination, current anxiety affected 49.9 percent versus 35.9 percent, current depression 26.6 percent versus 20.3 percent, and the mean count of functional difficulties was 2.7 versus 2.1. Roughly 21 percent of both groups lived below the federal poverty line. To account for these imbalances, the researchers fitted two survey-weighted multivariable logistic regression models side by side: a minimally adjusted model controlling for sociodemographic factors, and a fully adjusted model that additionally included insurance status, current anxiety, current depression, and functional difficulty count.

The weighted 12-month emergency visit rate was 29.0 percent among children who received needed care coordination versus 40.0 percent among those who did not, an 11-percentage-point gap. In the minimally adjusted model, receipt of coordination was associated with lower odds of any emergency use, with an adjusted odds ratio of 0.61. The association persisted in the fully adjusted model at an adjusted odds ratio of 0.69, and it was even more pronounced for recurrent visits of two or more encounters, where the adjusted odds ratio fell to 0.54, an approximate 46 percent reduction in odds. The estimate for overnight hospital stays was imprecise and included the null, at an adjusted odds ratio of 0.61 with a confidence interval spanning 0.37 to 1.01.

The access findings were striking. Receipt of needed care coordination was associated with a 68 percent reduction in the odds of any unmet healthcare need, at an adjusted odds ratio of 0.32, and a 79 percent reduction in the odds of forgoing necessary mental health care, at an adjusted odds ratio of 0.21. Both estimates survived Benjamini-Hochberg false discovery rate correction applied to the family of secondary endpoints. Recurrent emergency use was analyzed as a pre-specified sensitivity outcome and was not included in the correction family.

Consistency analyses extended the pattern across clinical profiles and survey waves. Stratification by Children with Special Health Care Needs status yielded inverse associations in both subgroups, at an adjusted odds ratio of 0.76 among CSHCN children and 0.48 among those without the designation, with the stronger point estimate among non-CSHCN youth. The authors interpret these stratified estimates as descriptive consistency analyses rather than formal evidence of effect modification. Year-specific minimally adjusted models produced point estimates below 1.0 in each survey year, reaching conventional significance in 2023 and 2024 but not 2022, and a formal care-coordination-by-year interaction test was not statistically significant, providing no clear evidence that the association differed across survey years.

The authors are careful about what the data can and cannot show. Because the design is cross-sectional and both coordination receipt and emergency use share a 12-month recall window, temporal ordering cannot be established, and the findings are interpreted as descriptive evidence of differences in care experiences rather than proof that coordination caused lower acute-care use. Complete-case exclusions were small, at 0.3 percent in the minimally adjusted model and 2.9 percent in the fully adjusted model, but bias from missingness cannot be formally excluded. All measures were caregiver-reported rather than drawn from medical records, introducing potential recall bias and misclassification, and emergency use was measured as all-cause utilization rather than pain-specific encounters. The survey also lacks clinical granularity regarding pain duration, anatomical distribution, severity scores, underlying etiologies, and therapeutic regimens.

From a health services perspective, the findings suggest that care coordination may be an important component of pediatric pain management. Programs that incorporate designated care managers, proactive communication protocols between specialists and primary care clinicians, and expedited behavioral health referrals may alleviate operational strain on emergency departments. If replicated in longitudinal or interventional studies, the results may inform the design of integrated pediatric pain-care pathways and systemic incentives such as value-based pediatric alternative payment models and dedicated reimbursement codes for non-face-to-face care management, which remain underutilized or insufficiently compensated in many state Medicaid and commercial insurance programs. For now, the message for clinicians and policymakers is that emergency department encounters among children with chronic pain may signal addressable vulnerabilities in outpatient delivery, not merely disease severity.

Subject of Research: Care coordination and emergency department utilization among US children with chronic physical pain

Article Title: Receipt of needed care coordination and emergency department utilization among US children with chronic physical pain: a pooled analysis of the 2022–2024 National Survey of Children's Health

Article References: Cheng, T., Cai, Z., Zhou, X., Lai, C., Huang, L., & He, W. (2026). Receipt of needed care coordination and emergency department utilization among US children with chronic physical pain: a pooled analysis of the 2022–2024 National Survey of Children's Health. Frontiers in Pain Research, 7, Article 1994046. https://doi.org/10.3389/fpain.2026.1994046

Image Credits: AI Generated

DOI: 10.3389/fpain.2026.1994046

Keywords: care coordination, chronic pain, pediatrics, emergency department utilization, National Survey of Children's Health, healthcare access, pediatric pain, health services research, mental health care, children with special health care needs, Receipt, needed