Objectives The aim of this study is to observe the trends in the mental health presentations of 10 to 16-year-olds to the paediatric emergency department (ED) in Belfast over a two year period, capturing the onset and peak of the COVID-19 pandemic.

Methods Data was gathered on attendances to a paediatric ED between October 2019, prior to the announcement of the COVID-19 pandemic, until October 2021. Data was collected on demographics including postcode, as well as trends of the presentations including reasons for presentation, timing of presentations, and outcomes following emergency department attendance.

Results There were 488 presentations between the start of October 2019 and the end of October 2021, of which the ratio of male-to-female was 19.7%:80.3%. A majority (76.0%) of cases presented out-of-hours. The peak number of admissions were in May 2021 with a total of 33. The overall admission rate was 26.8% of overall presentations. Of the 131 cases which resulted in admission, 3 patients (2.3%) were referred directly to the paediatric intensive care unit (PICU). The most common cause of presentation and admission was overdose which made up 40.0% of cases.

Conclusions During the pandemic, the hospital saw an increase in the number of young people with mental health difficulties in ED. Peaks in presentations were noted initially at the easement of restrictions around 5 months following onset of lockdown. The data also allowed us to look at demographic presentation areas using post codes which could potentially be targeted by community teams. The literature acknowledges notable variations in the specific types of presentations, with an increased proportion being due to self-harm and eating disorders. There may be a link between the environmental factors of being under lockdown with limited social contact and increased online media consumption causing adolescent health to deteriorate in specific ways.