Whereas the previous episode was a milestone for the series with an extremely daring move in the seasonal narrative, this one feels out of place. It is reminiscent of earlier "Buffy" episodes, back when they weren't quite sure what this series would be about. Since there are still four episodes left this season, perhaps these episodes serve to pad the season so they could have Buffy confront Angelus in the finale as would be dramatically appropriate.
Considering what happened, it would make sense for Buffy to feel responsible and helpless over what happened to Jenny. So they explore that by detailing Buffy's hospital fear after helplessly watching her cousin die when she was younger. Apparently Buffy had no problem empowering herself long before she was called, but that impotence when faced with the loss of someone close has remained too.
When children start to die at an alarming rate, Buffy puts the pieces together as a tangible foe, whereas her friends believe she's doing so to deal with her feelings after Jenny's death. She isn't comfortable in situations where she doesn't have control. Ultimately to confirm her beliefs that there is something beatable diminishes the impact of her character's story. Although they slipped into this throughout the series, they would get better at handling the situation.
There are three separate threads to this episode: the past with Buffy and her cousin, der Kinderstod and Buffy's feelings of helplessness. Ultimately they don't come together, even if it's clear what they were trying for when they made this episode. Some things are glaringly tacked on, like Willie Garson's security guard character who had some admiration for the controversial doctor (luckily the actor would have more to work with as Carrie's gay best friend on "Sex and the City"). Another episode mourning Jenny might've been a better call.
Making Buffy sick is a possible solution, but the way they go about it is too ridiculous to swallow. How exactly would Willow know the vial in Dr. Backer's cabinet would be poisonous in its pure form and would have to be diluted, not to mention how much water she would need to dilute it properly? By taking the point of Buffy making herself weak so she can confront her weakness down this avenue, it diminishes the point they were trying to make.
There are some more glaring plot holes as well. For a doctor to go missing with a bunch of children dying, wouldn't it make sense for someone to connect the two and surmise they are related? Kinderstod's murder of Dr. Backer isn't clear either: instead of keeping a low profile, going after a healthy doctor is going to raise eyebrows, even if the demon can't be seen from a healthy person's perspective. Also, why isn't security airtight?
The most satisfying point of the episode is Xander playing Buffy's "white knight" when Angelus tries to mockingly leave some flowers for her. While Xander is a character frequently bogged down by his own insecurities, he'll still able to pull through with moments like these. Standing up to one of the greatest monsters of all time, not to mention one who is going for the emotional jugular, is a major victory.
His defense and allegiance to Buffy continues to strain his relationship with Cordelia. The fact that they can never have a happy romantic relationship because of Xander's attachment to Buffy becomes increasingly clear. While they made up after Xander's love spell debacle, it was hardly a smooth reunion. She was flattered that he went to such lengths!
Another brief moment is Joyce's words of consolation to Giles. Considering his death wish at the end of the last episode, it's unfortunate not enough was done in this episode. It does add a little to the connection between Joyce and Giles that has been brewing this season.
Overall, this episode was completely unnecessary, throwing the series back a few steps after the landmark "Passion" episode. Things don't add up when they should. It's an unfortunate place to put such an episode as things with Angelus were driven to new heights (or lows), but perhaps this episode is another example of them filling out the 22-episode order.