Between two and three million children attend accident and emergency (A&E) departments every year in the United Kingdom, making up one quarter of all A&E attendances (Bentley 1996). Despite government, professional and consumer guidance (Audit Commission 1996, Action for Sick Children 1997), the majority of children are not seen in a children’s A&E or cared for by appropriately-trained staff. This study explored the pattern of attendance of 375 children aged five years and under who attended the A&E department in a district general hospital. Issues of service provision and quality of care were also explored using secondary data from A&E records. Key findings were that one third of the children were triaged with non-urgent illness, suggesting a need for improved access to GP services and that a number of children were referred by GPs and admitted via A&E rather than directly to the paediatric ward. Although waiting times were generally short, many children did not appear to receive analgesia, suggesting the need for improved pain assessment and management.