Introduction:
Refusal of hospitalisation and DAMA in paediatric patients are insufficiently studied, especially in Poland and Central and Eastern Europe. These decisions may affect safety and care continuity and are shaped by medical and non-medical factors.

Aim:
To analyse the frequency, circumstances, and selected determinants of refusal of hospitalisation and DAMA among patients in the Pediatric Ward of the Independent Public Provincial Specialist Hospital in Chełm 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. Patients recorded during the first 10 days of each month in 2013–2018 were included. Variables were age, sex, ICD-10 diagnosis, mode of admission, length of stay, and discharge type. Analysis used Microsoft Excel and R 4.0.5, with 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 often admitted by Emergency Medical Services than all cases (46.6% vs. 21.5%). Gastrointestinal disorders and infections were the most common diagnoses.

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.