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Previous research investigating the impact of COVID\u201019 on young children's mental health service utilization has rarely included children under 5 years. Therefore, this study examined how the COVID\u201019 pandemic and the caregiver\u2010child relationship impacted children's mental health symptoms. It also investigated the impact of COVID\u201019 and the child's symptom presentation on caregivers\u2019 engagement and attendance in mental health treatment. Data were collected with children 0 to 5 years old (<jats:italic>n<\/jats:italic>\u00a0=\u00a0486) from January 2017 to April 2022 using archival records from a community mental health organization. Participants were primarily low\u2010income (81.9%) and White (81.3%). Results found that the caregiver\u2010child relationship impacted children's mental health symptoms before and during the COVID\u201019 pandemic. Both caregivers and children were rated as more engaged after the pandemic began if the child experienced externalizing symptoms. Children attended fewer therapy sessions after the pandemic started, and those with externalizing symptoms received more overall services than those without.<\/jats:p>","DOI":"10.1002\/imhj.70005","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T08:15:50Z","timestamp":1740039350000},"page":"228-244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impacts of COVID\u201019 on early childhood mental health"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1690-5165","authenticated-orcid":false,"given":"Marissa","family":"Marsolek","sequence":"first","affiliation":[{"name":"Department of Psychology University of Minnesota Duluth  Duluth Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7540-928X","authenticated-orcid":false,"given":"Kathy","family":"Dowell","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Minnesota Duluth  Duluth Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"American Academy of Child and Adolescent Psychiatry. 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