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To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic.

Birth cohort.

National Health Service hospitals in England.

All children aged <5 years with a birth recorded in hospital administrative data (January 2010–March 2021).

Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks’ gestation) or low birth weight (<2500 g).

Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020–2021).

Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than …