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Background: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital., Methods: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods., Findings: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45)., Conclusion: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings., Application to Practice: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting., Competing Interests: Declaration of competing interest Authors do not have any interests to report related to this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)