Psychiatric emergency services for children and adolescents vary in process, structure and outcome. There are few systematic studies on the type and prevalence of psychiatric problems encountered, related circumstances or resulting interventions. Evidence in these areas is important in evaluation of the function of mental health services in the relevant catchment area. This article presents a cohort study of 466 consecutive consultations that took place in the Amsterdam Child Psychiatric Emergency Service in 2008, with data on clinical, demographic and consultation-related characteristics. A majority of the consultations (51.5%) was related to behavioural problems in the context of heavily strained relationships. A total of 23.4% consultations were related to neglect or abuse. Parental mental illness prompted 12% of the consultations. Psychiatric diagnoses in the child as such were limited. The main Diagnostic and Statistical Manual of Mental Disorders classification was a relational problem (70%). These crises were serious and often necessitated temporary placement. Hospitalisations on a psychiatric ward and/or pharmacological intervention were rare. Regular mental healthcare providers may specifically need to add psychiatric evaluation and treatment strategies when confronted with disruptive disorders. Additional preventive measures and firmer inter-agency collaboration may ameliorate the containment of problems in these children and their families. © 2012 The Child Care in Practice Group.