Young children with psychiatric complaints in the pediatric emergency department

Children are increasingly diagnosed with mental illnesses and self-harm behaviors. They present frequently to the emergency department (ED) for evaluation. The aim of this study is to describe the youngest children in the ED with psychiatric issues. This is a retrospective chart review of all consecutive children less than 10 years of age with a psychiatric complaint who received a psychiatric consultation in the pediatric emergency department in the last four years. The number of children with psychiatric issues increased over the study period. The ED length of stay also increased. Violent behavior and aggression were the most common chief complaints, and some children required chemical or physical restraint in the ED. Many children had pre-existing psychiatric issues and a history of adverse childhood experiences. Half of patients were deemed safe for discharge home by psychiatric consultation. The number of young children with psychiatric complaints presenting to the ED has increased. However, a large number are found to be stable for discharge home. Increase in urgent outpatient psychiatric resources could help decrease ED utilization. •Children with psychiatric concerns have long emergency department lengths of stay.•Aggression and violence are common presenting complaints in young children.•Pre-existing psychiatric issues and adverse childhood experiences are often present.•Urgent outpatient resources, especially for foster children, could improve care.