Newberry-Dupe, J.Melvin, G.King, K.White, M.J.Anderson, V.Babl, F.E.Borland, M.L.Dalziel, S.R.Hiscock, H.Tonge, B.J.Buntine, P.Charters, B.Hamilton, M.Kochar, A.Meyer, A.Tran, V.Aldridge, E.Barrington, G.Hackett, L.Lowry, N.et al.2025-07-162025-07-162025Journal of Paediatrics and Child Health, 2025; 61(6):910-9181034-48101440-1754https://hdl.handle.net/2440/145979Objectives Although child and adolescent mental health and behavioural presentations to hospital emergency departments (EDs) increased during the first 2 years of the COVID-19 pandemic (2020 and 2021), little is known about the characteristics of these presentations. We aimed to compare demographic, clinical and psychosocial profiles of paediatric presentations to Australian EDs before and after the onset of the pandemic. Methods We conducted a retrospective observational study of 100 randomly sampled presentations by children (6–11-year-olds) and adolescents (12–17-year-olds) to 10 Australian EDs between 1 January and 31 December 2019 (pre-COVID-19) and 1 January and 31 December 2021 (COVID-19). Using a multilevel factor model, we compared the pre-COVID-19 and COVID-19 cohorts regarding demographic characteristics, diagnoses, precipitants, time-to-treatment, length of stay, and discharge disposition. Results The COVID-19 period was characterised by increased presentations by adolescents and girls. Compared to the pre-COVID-19 cohort, the COVID-19 cohort experienced increased median waiting times (48 and 72 min, respectively), median length of ED stay (4.7 and 5.4 h), and likelihood of admissions to the ED short stay unit (9.5% and 12.9%). Patients in the COVID-19 cohort were more likely to present with self-harm and suicidal thoughts/behaviours, eating disorders, neurodevelopmental and neurocognitive disorders, and psychosocial stressors, and less likely to have diagnoses of disruptive behaviour, impulse control, and conduct disorders. Conclusions Young people presenting to the ED in 2021 for mental health reasons were more likely to wait longer, stay longer, have a diagnosis of intentional self-harm and/or a neurodevelopmental disorder, and report psychosocial stressors.en© 2025 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.adolescentAustraliaCOVID‐19emergency departmentlockdownmental healthpaediatricRetrospective StudiesMental DisordersPandemicsSARS-CoV-2Journal article10.1111/jpc.70046734120