Pediatric Mental Health Boarding: 2017 to 2023

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 < .001) and 350 (0.3%) children had stays of longer than 100 days. Boarding practices varied significantly by hospital site. Factors associated with prolonged boarding included older age, government insurance type, increasing medical complexity, specific psychiatric disorder, season of presentation, and discharge disposition to home.

Boarding while awaiting acute psychiatric care remains common, with a sustained increase in the volume of boarding encounters and length of stay since the onset of the COVID-19 pandemic. Patients with medical and/or psychiatric complexity may be more likely to experience prolonged boarding, highlighting an area for improved access to care.