A multicenter retrospective cohort study of 143 pediatric patients diagnosed with catatonia between 2018 and 2023 found that the median age was 15 years, with 46.2% female. Neurodevelopmental disorders were present in 38.5% of patients. The Bush Francis Catatonia Rating Scale (BFCRS) was used to assess catatonia severity, with a mean score of 15.0 ± 5.9. Six signs were present in more than 50% of patients, while four were present in less than 20%. Patients with neurodevelopmental disorders had a higher BFCRS severity score than those with other diagnoses. Catatonia was associated with significant morbidity and a 60-fold higher risk of death than the general population. The study highlights the need for further research into optimal diagnostic criteria for catatonia in children, as well as the clinical course of the disorder. The findings suggest that catatonia in children is a complex condition that may overlap with other disorders, and that timely diagnosis and treatment are critical. The study also emphasizes the importance of using validated rating scales and considering the unique features of catatonia in different populations. The results provide a clearer understanding of the clinical features of catatonia in youth and highlight the need for continued research into the diagnosis and treatment of this condition.A multicenter retrospective cohort study of 143 pediatric patients diagnosed with catatonia between 2018 and 2023 found that the median age was 15 years, with 46.2% female. Neurodevelopmental disorders were present in 38.5% of patients. The Bush Francis Catatonia Rating Scale (BFCRS) was used to assess catatonia severity, with a mean score of 15.0 ± 5.9. Six signs were present in more than 50% of patients, while four were present in less than 20%. Patients with neurodevelopmental disorders had a higher BFCRS severity score than those with other diagnoses. Catatonia was associated with significant morbidity and a 60-fold higher risk of death than the general population. The study highlights the need for further research into optimal diagnostic criteria for catatonia in children, as well as the clinical course of the disorder. The findings suggest that catatonia in children is a complex condition that may overlap with other disorders, and that timely diagnosis and treatment are critical. The study also emphasizes the importance of using validated rating scales and considering the unique features of catatonia in different populations. The results provide a clearer understanding of the clinical features of catatonia in youth and highlight the need for continued research into the diagnosis and treatment of this condition.