OBJECTIVE To describe patient demand and management in a hospital pediatric emergency setting. PATIENTS AND METHOD We analyzed the number of episodes registered in our pediatric emergency unit between 1995 and 2002 and performed a retrospective, random survey of 540 episodes in children aged less than 14 years admitted between 2001-10-1 and 2002-09-30. Epidemiological details, physical findings, complementary tests, the treatment administered, admissions, and unscheduled return visits were analyzed. RESULTS Between 1995-1-01 and 2002-31-12, a total of 337,842 episodes were registered in our emergency unit, requiring 11,767 (3.48 %) admissions to a ward or the pediatric intensive care unit (PICU). The number of episodes/ year increased from 38,659 in 1995 to 51,933 in 2002 (Delta = 34.3 %). The mean age of the sample (n = 540) was 3.5 6 3.2 years (54.6 % were younger than 3 years) and 306 (56 %) were boys. Nearly one-third of the children presented with processes of recent onset (less than 6 hours). The most frequent chief complaints were fever in 160 children (29.6 %), respiratory distress in 78 (14.4 %) and vomiting-diarrhea in 65 (12 %). Complementary investigations were performed in 176 patients (32.6 %), mainly radiologic tests (115; 21.2 %). One hundred fifty-three (28.3 %) received treatment in our emergency unit, mainly antipyretics and bronchodilators. Sixty-five percent stayed less than 1 hour in the emergency unit. The most frequent diagnoses were fever without source in 66 patients (12.2 %), diarrhea/acute gastroenteritis in 40 (7.4 %), asthma in 35 (6.5 %), and croup in 27 (5 %). Sixteen children (3 %) were admitted to a ward and three (0.6 %) were admitted to the PICU. Home drug treatment was recommended in 359 patients (71.8 %). Unscheduled return visits were registered in 59 patients (10.9 %), and five were admitted. CONCLUSIONS The number of patients attended in our pediatric emergency unit gradually increased between 1995 and 2002, mostly due to young children with fever or respiratory distress. In nearly half of the patients, a thorough anamnesis and physical examination were sufficient for evaluation. Because many of the processes were of recent onset, continuous observation, whether at home or in hospital, was useful to adequately monitor these children.