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This review article examines the National Institutes of Health's (NIH) overall budget and its pediatric research funding across three time periods: predoubling [fiscal year (FY) 1992-1997]; doubling (FY 1998-2003); and postdoubling (FY 2004-2009). The average annual NIH appropriations increased by 5.4%, 13.4%, and 1.3% in each period, respectively. The average annual pediatric research funding (actual grants, contracts, intramural research, and other mechanisms of support) increased much less, by 4.7%, 11.5%, and 0.3% in each period, respectively. Between FY 2004 and FY 2007, the average NIH budget increase has nearly flattened, to only 1.96%. During this period, average pediatric research funding has dropped markedly lower, to 0.57%; estimated FY 2008 pediatric funding is at negative 0.5%. Although pediatric research enjoyed significant benefits of the NIH doubling era, the proportion of the NIH budget devoted to the pediatric research portfolio has declined overall. The most recent period has wiped out the annual gains of the doubling era for both pediatric and overall NIH research funding. We offer recommendations to protect against further erosion of pediatric research funding and to implement several unfulfilled commitments to strengthen the federal pediatric research portfolio in the coming decade.

That Sinking Feeling, Again? The State of National Institutes of Health Pediatric Research Funding, Fiscal Year 1992–2010