Nasogastric tube insertion results in very high FLACC scores irrespective of lidocaine use. Nebulized lidocaine cannot be recommended as pain relief for nasogastric tube insertion in children. The delay and distress of nebulization likely outweigh a possible benefit in the postinsertion period.

Aim Limited recent interstate evidence suggests an increase in paediatric mental health presentations to emergency departments in Australia. We set out to confirm this and whether any specific diagnosis was responsible for this increase. Methods We identified all patients with mental health presentations aged 6–18 years who attended our tertiary emergency department from January 2006 to June 2019 using our emergency department patient record system. Patients were determined to have a mental health presentation if they had a discharge diagnosis or presenting complaint code that corresponded to a mental health disorder or were referred to the mental health team. For analysis, we divided the 13.5‐year duration of our study into three periods of 4.5 years. Results Comparing the first and last time periods, there was a 156% increase in mental health presentations over 9 years. This was out of proportion to the increase in combined general and mental health presentations of 11.9%. There was an increase in the proportion of patients who were diagnosed with an adjustment disorder (14–26.6%) or a childhood emotional disorder (8.5–20.8%). Additionally, there was an increase in median wait time and a reduction in the proportion of patients seen within their recommended triage time. Conclusion There is a large increase in the number of paediatric mental health presentations to our emergency department. Further resources may need to be allocated to mental health services in the community and in the emergency department.