Introduction: The COVID-19 pandemic poses unprecedented challenges for healthcare services and has led to changes in the usage pattern of the pediatric population. We aimed to describe the impact of COVID-19 on children’s health, wellbeing, and access to medical care in Portugal.Material and Methods: We conducted a cross-sectional study through an anonymous online survey via social media. The collected data refers to a period between the 16th of March and the 17th of May 2020.Results: We obtained responses to the survey on 19 745 children. Of the previously scheduled outpatient consultations, 54.2% were postponed by healthcare institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children due to the pandemic.Discussion: The observed reduction of pediatric emergency department visits and the postponement of outpatient consultations and vaccine administrations are potentially harmful for non-COVID patients. The current pandemic and the imposed social distance might have an important negative impact on the mental health of children.Conclusion: Further studies are necessary to fully comprehend the outcomes of the decreased access to medical care, as well as the collateral damage for children beyond the clinical aspects of the pandemic. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority.

RESUMOIntrodução: O abandono de doentes do serviço de urgência pediátrico antes da observação médica constitui um problema multifatorial. Procurámos comparar características sociodemográficas de crianças que abandonaram a urgência e das que não abandonaram, assim como avaliar os motivos, recurso subsequente a cuidados de saúde e outcome clínico. Material e Métodos: Estudo caso-controlo prospetivo de amostra aleatória de crianças que abandonaram a urgência e de controlos pareados durante um período de três meses. Foi realizado um questionário telefónico para recolha de informação relacionada com os motivos para o abandono, outcomes clínicos e opiniões gerais. Material and Methods:This was a prospective case-control study of a random sample of children who left without being seen and their matched controls from an emergency department during a three-month period. We performed a phone questionnaire to obtain information concerning reasons for leaving, patient outcomes and general feedback.Results: During the study period, 18 200 patients presented to the emergency department, of whom 92 (0.5%) left without being seen. Fifty-five (59.8%) completed the questionnaire and there were 82 controls. The most common reasons for leaving were 'excessive waiting time' (92.7%) and 'problem could wait' (21.8%). A significantly higher number of patients who left sought further medical care (78.2% vs 11%) but they did not experience higher levels of unfavourable outcomes. Discussion: The waiting time seems to be the major factor that drives the decision to leave. The fact that parents felt safe in leaving and the low level of adverse outcomes highlights the low-acuity nature of the majority of patients who leave. Conclusion:Reducing the waiting times may be the logical strategic mean to decrease the rates of patients who leave without being seen. However, our data seems to indicate that the concerns surrounding clinical outcome after leaving may be partly unwarranted.

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