Introduction:
Refusal of hospitalisation and discharge against medical advice (DAMA) in paediatric patients remain insufficiently studied, particularly in Poland and other Central and Eastern European countries. These decisions may affect patient safety and continuity of care and are influenced by both medical and non-medical factors.

Aim:
The aim of the study was to analyse the frequency, circumstances, and selected determinants of refusal of hospitalisation and discharge against medical advice among paediatric patients hospitalised in the Pediatric Ward of the Independent Public Provincial Specialist Hospital in Chelm in 2013–2018.

Material and methods:
This retrospective study analysed medical records of patients under 18 years of age presenting to the Emergency Department, Admission Rooms, and Pediatric Ward. The study included patients recorded during the first 10 days of each month between 2013 and 2018. Extracted variables included age, sex, ICD-10 diagnosis, mode of admission, length of stay, and discharge type. Statistical analysis was performed using Microsoft Excel and R version 4.0.5, with significance set at α = 0.05.

Results and Discussion:
Among 6,525 analysed cases, refusal of hospitalisation occurred in 4.9% (n = 320). Among 2,315 hospitalised patients, discharge at the request of a legal guardian occurred in 11.4% (n = 263). DAMA patients were more frequently admitted via Emergency Medical Services than the overall study population (46.6% vs. 21.5%). Gastrointestinal disorders and infections were the most common diagnoses across all groups.

Conclusions:
Refusal of admission and DAMA were not rare in this paediatric population. Further prospective studies are needed to identify causes and support interventions aimed at reducing these events.