Recent trends and structural patterns in NIH pediatric research funding, 2015-2024.

BACKGROUND

National Institutes of Health (NIH) pediatric research funding has persistently lagged behind children's share of the US population and disease burden. This study examined trends in NIH pediatric research expenditures, funding distribution across NIH components, and classification accuracy of the NIH Research, Condition, and Disease Categorization (RCDC)'s system for identifying pediatric research.

METHODS

We conducted a repeated cross-sectional analysis of RCDC, NIH Office of Budget, and NIH RePORTER data from fiscal years (FY) 2015-2024. Expenditures were inflation-adjusted using the Biomedical Research and Development Price Index (BRDPI). A stratified random audit of 200 RCDC Pediatric-category projects assessed classification accuracy.

RESULTS

NIH research expenditures grew 62% nominally (FY2015: $28.5 billion; FY2024: $46.1 billion), but only 26% in inflation-adjusted dollars. Pediatric research consistently comprised approximately 13% of NIH nonadministrative expenditures, despite children <18 years-old constituting 22% of the US population. Five institutes accounted for 57% of pediatric research expenditures. The audit identified a 6% misclassification rate, clustering around maternal health studies lacking pediatric outcomes.

CONCLUSION

NIH pediatric research funding remained proportionally stagnant, rising passively with the NIH budget rather than reflecting deliberate prioritization. Strengthening pediatric and life-course research may require more coordinated trans-NIH prioritization.

IMPACT: In nominal dollars, pediatric research funding at the NIH rose from $3.5 billion in FY2015 to $6.2 billion in FY2024; however, adjusted for inflation, the level of funding plateaued from FY2020 to FY2024. As a proportion of NIH nonadministrative expenditures, pediatric research accounted for approximately 13% across FY2015-FY2024. Although NICHD devoted 58-60% of its research funding to pediatric studies, it accounted for just 17% of all pediatric research funding. Every NIH component funded some amount of pediatric research, but the NIH lacks a coordinated trans-NIH strategy for pediatric research prioritization and oversight.