About 15 years ago, I had an infant with RSV. We started off with treatment at home but were told that if things went south, she needed to go to Texas Children's where she had previously been a patient as they had the most appropriate care for more complex situations like hers. Her local doctor was clear that the local hospitals would be able to stabilize, if necessary, but that infants/kids were not just "little adults" and the care was a specialty that simply was not avail locally as the need was not high enough to justify the staffing of pediatric specialists.
He also mentioned that with excellent options like Texas Children's and Dell Children's and Temple so close that it would be many years, if ever, that we had a children's facility locally.
That said, over the last 15 years, things have improved for pediatric specialty care and we have been able to see pediatric specialty doctors that came to College Station a couple days a month so that routine specialty care did not always involve a trip out of town. Inpatient stuff has always required a trip but we always felt blessed to be less than 2 hours from multiple, excellent pediatric hospitals when needed.