["Child: Care, Health and Development, Volume 52, Issue 4, July 2026. ", "\nABSTRACT\n\nBackground\nThis study examined psychiatric presentations among children and adolescents (C&A) in Alberta, Canada, across pre‐pandemic, pandemic and post‐pandemic periods, with a focus on age, biological sex and urban/rural status.\n\n\nMethods\nUtilizing a retrospective cohort design, we analysed health administrative billing data from 1 430 441 psychiatric encounters among Albertans aged 0–17 between 2017 and 2022. Service utilization rates were compared across pandemic phases, and associations were evaluated using one‐way ANOVAs and generalized linear models stratified by healthcare setting.\n\n\nResults\nTotal psychiatric presentations increased significantly post‐pandemic, driven by a 21.3% surge in outpatient settings. One‐way ANOVA (p = 0.014) and regression modelling confirmed that both pandemic phase (p = 0.014) and age (p = 0.03) significantly influenced utilization. Adolescents accounted for 64% of encounters and were the most heavily impacted cohort. Outpatient increases were primarily phase‐driven (p = 0.004), whereas emergency and inpatient encounters were strongly influenced by age and sex (p < 0.001), with female adolescents experiencing the highest rates (significant age × sex interaction, p < 0.001). Conversely, rural presentations declined sharply during the pandemic (−35.2%) and only partially rebounded post‐pandemic (+17.4%).\n\n\nConclusion\nThe psychological impacts of the pandemic were highly stratified by demographic factors and care settings, with adolescent females showing acute distress in acute care, and rural youth experiencing persistent service gaps. These findings underscore an urgent need for targeted mental health resources, equitable geographic access and tailored interventions across diverse youth cohorts.\n\n"]