Publication date: Feb 13, 2025

Boarding for pediatric mental health (MH) conditions is common at US children’s hospitals while patients await care at a psychiatric facility. We sought to describe recent trends in boarding encounters and to identify factors associated with prolonged length of stay. We performed a retrospective cross-sectional study analyzing pediatric MH boarding encounters at 40 tertiary children’s hospitals included in the Pediatric Health Information System database between January 1, 2017, and December 31, 2023. Children ages 3 to 18 presenting with a primary psychiatric diagnosis were included in the analysis. We assessed trends in boarding encounters and length of stay over time and analyzed variations in boarding practices among hospitals. Risk factors for prolonged boarding (≥9 days) were identified using mixed effects logistic regression models. Between 2017 and 2023, there were 100 784 boarding encounters across 40 hospitals. Median length of stay for boarding encounters increased from 3 to 4 days (P 

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