Pediatric Mental Health Patients Boarded in Emergency Departments for Lengthier Times Awaiting Inpatient Psychiatric Services

Children and adolescents experiencing a mental health crisis are spending a significantly longer time “boarding” in emergency departments – sometimes for as long as 100 days – because of limited inpatient capacity at psychiatric hospitals, according to new research. A study, “Pediatric Mental Health Boarding: 2017-2023,” published in the March 2025 Pediatrics (published online Feb. 13) analyzed boarding encounters at 40 tertiary children’s hospitals included in the Pediatric Health Information System (PHIS) database between January 1, 2017, and December 31, 2023. Boarding is defined as an extended overnight stay in an emergency department or inpatient medical unit while waiting for placement in a setting designed for mental health care treatment. Researchers found that the number of patients ages 3-18 presenting with a primary psychiatric diagnosis almost doubled during that time, highlighting a substantial strain on acute care facilities. Out of 665,457 total primary pediatric mental health encounters, 100,784 (15%) had a length of stay in the emergency department or inpatient medical unit of two or more days. The median length of stay for the 100,784 boarding encounters increased from 3 to 4 days and 350 (0.3%) children experienced stays of longer than 100 days. Boarding levels have remained high since the onset of the COVID-19 pandemic and have negative physical and psychological effects on children. The authors call for urgent efforts at both the hospital and state level to improve access and uptake of outpatient community-based mental health services to prevent acute crisis hospitalization.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.