Divergent Shifts in Paediatric Emergency Care Before, During, and After the COVID-19 Pandemic: An Interrupted Time Series Analysis

When a community faces a sudden, widespread threat, the way people seek medical help often changes in ways that are hard to predict. In the world of emergency medicine, doctors and planners rely on steady patterns to keep hospitals running smoothly. They know, for instance, that some visits are for life-threatening emergencies, while others are for minor issues that could be handled elsewhere. Before a crisis hits, these patterns usually shift slowly over years as new technologies and public health campaigns encourage people to avoid the emergency room for small problems. But when a global pandemic arrives, bringing with it strict rules about staying home and fears of catching a virus in a crowded waiting room, those steady patterns can break. The question becomes not just how many people show up, but who shows up, and for what reasons. Understanding these shifts is vital because it tells hospitals how to prepare their staff and resources for the next time the world turns upside down.

A team of researchers in Canada set out to map exactly how the COVID-19 pandemic changed the flow of children into emergency departments across the province of Ontario. They looked at a massive amount of data, tracking every visit to 206 different emergency rooms over more than a decade, from 2011 to 2023. This long timeline allowed them to see what was happening before the virus arrived, how the numbers crashed when the pandemic began, and how they climbed back up afterward. The researchers separated the visits into two main groups: urgent cases, where a child needed immediate, serious care, and non-urgent cases, which were less critical. They also broke the data down by age, looking at toddlers, young children, pre-teens, and teenagers separately. Their goal was to see if the pandemic simply paused the usual trends or if it permanently altered how families use emergency care.

The story the data tells is one of a sharp, sudden drop followed by a slow, uneven return to normal. Before the pandemic started in early 2020, the number of urgent visits for children was slowly creeping up, while non-urgent visits were slowly going down, a sign that the healthcare system was successfully encouraging people to use other options for minor issues. Then, in March 2020, everything changed. As public health measures like stay-at-home orders took effect, the number of children walking through emergency room doors plummeted. The drop was severe across the board, but it hit the youngest children the hardest. The number of visits for children aged zero to four fell by nearly 59 percent almost overnight. Even the oldest group, teenagers, saw a significant drop of over 45 percent. It appeared that parents were keeping their children home, likely fearing exposure to the virus in a hospital setting, or perhaps because the children were simply less sick due to fewer people circulating in schools and playgrounds.

As the months passed, the emergency rooms began to fill up again, but the path back to normal was not the same for every group. The researchers found that the volume of visits eventually recovered to pre-pandemic levels by the end of the study period in May 2023. However, the mix of patients had shifted. The return of urgent visits, especially for the youngest children, was much faster and steeper than the return of non-urgent ones. The toddlers and young children who had vanished from the waiting rooms came back quickly, often with serious conditions that required immediate attention. In contrast, the recovery of non-urgent visits was slower and more varied. For teenagers, the return of non-urgent visits was actually faster than the return of urgent ones, suggesting that older children were using the emergency room for different reasons than they had before, possibly related to mental health or other issues that became more pressing during the isolation of the pandemic.

The researchers suggest that these different recovery patterns reflect how families of different ages reacted to the crisis. Younger children are more susceptible to common infectious diseases, and when they do get sick, their parents are often quick to seek help, leading to a rapid rebound in urgent visits for that age group. Older children and teenagers, on the other hand, may have had more access to virtual care or other ways to handle minor concerns, or they may have delayed seeking help for less critical issues until the immediate fear of the virus subsided. The study also noted that the initial drop in visits was likely a mix of two things: fewer children actually getting sick because they stayed home, and fewer parents willing to bring them to the hospital even when they were sick. This means the data reflects a change in behavior as much as a change in the health of the children themselves.

Ultimately, this long-term look at the data reveals that the pandemic did not just pause the emergency room; it accelerated a shift in the type of care children need. The system is now seeing a higher proportion of urgent cases, particularly among the very young, compared to the pre-pandemic era. This finding is crucial for hospital administrators and health planners. It suggests that when the next public health emergency strikes, emergency departments cannot simply expect to return to the old balance of patients. They must prepare for a surge of serious cases, especially among toddlers and young children, while also recognizing that older children may present with different, perhaps less obvious, needs. The pandemic forced a change in how families interact with the emergency system, and that new way of thinking is here to stay.