The incidence of mental health disorders in children has dramatically increased for the past decade in both primary care and emergency department settings. Although there is no universally accepted definition for the emergency nature of a child or adolescent psychiatric condition, severity and urgency of the potential threat to the child’s and family’s safety and wellbeing, as well as available resources of the family and community determine its boundaries. Some situations such as aggressive and homicidal outbursts, acute psychotic or anxious states, serious suicide attempts, ingestions and intoxications, usually require emergency psychiatric attention for immediate medical and psychiatric diagnostic and therapeutic interventions. Also inadequacy of mental health resources in the community or inability of the family to use these resources may cause more chronic and less urgent presentations become a complete emergent condition. The psychiatric emergency visit may be the only interaction that a caretaker and child have with the mental health care system. Therefore, the emergency referral represents an important health care setting for the identification of mental illness and intervention in children.