This study aimed to characterize the symptoms of catatonia in pediatric patients and explore demographic and diagnostic factors associated with greater severity. A multicenter retrospective cohort study was conducted from January 1, 2018, to January 6, 2023, involving patients aged 18 and younger with a clinical diagnosis of catatonia. The Bush Francis Catatonia Rating Scale (BFCRS) was used for symptom assessment. The study included 143 patients, with a median age of 15 years and 46.2% being female. Neurodevelopmental disabilities were present in 38.5% of patients. On the BFCRS, patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia, with a mean BFCRS score of 15.0 ± 5.9. Six signs (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity) were present in more than 50% of patients, while four signs (waxy flexibility, mitgenen, gegenhalten, grasp reflex) were present in less than 20% of cases. In an adjusted model, patients with neurodevelopmental disorders showed greater BFCRS severity compared to those with other diagnoses. The study highlights the need for further research to define optimal diagnostic criteria for catatonia in pediatric patients and to clarify the clinical course of the disorder.This study aimed to characterize the symptoms of catatonia in pediatric patients and explore demographic and diagnostic factors associated with greater severity. A multicenter retrospective cohort study was conducted from January 1, 2018, to January 6, 2023, involving patients aged 18 and younger with a clinical diagnosis of catatonia. The Bush Francis Catatonia Rating Scale (BFCRS) was used for symptom assessment. The study included 143 patients, with a median age of 15 years and 46.2% being female. Neurodevelopmental disabilities were present in 38.5% of patients. On the BFCRS, patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia, with a mean BFCRS score of 15.0 ± 5.9. Six signs (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity) were present in more than 50% of patients, while four signs (waxy flexibility, mitgenen, gegenhalten, grasp reflex) were present in less than 20% of cases. In an adjusted model, patients with neurodevelopmental disorders showed greater BFCRS severity compared to those with other diagnoses. The study highlights the need for further research to define optimal diagnostic criteria for catatonia in pediatric patients and to clarify the clinical course of the disorder.