This study was conducted to compare the profile of patients attending the pediatric emergency services of a tertiary care teaching and referral hospital, Chandigarh, and a community level hospital in Ambala district, Haryana. Records of children (<or=12 years) attending emergency services over a period of one year; from 1st March 1999 to 28th February 2000, at both the health facilities were analyzed for demographic details, diagnostic categories, monthly trends of illnesses and mortality pattern. Five hundred ninety six children attended the Community Hospital's emergency service while 8301 children were seen at the pediatric emergency service of the tertiary care hospital during the same period. The most common morbidities at both the centers were diarrhea and respiratory infections (58% at community hospital, 45% at tertiary care hospital respectively). Neonatal illnesses and CNS diseases were other important morbidities. There was a significant use of emergency facilities for management of trivial complaints. At tertiary care hospital 26% of AR1 cases had upper respiratory infections, while 70% of diarrhea cases seen were without dehydration. At both the hospitals neonatal deaths formed the major proportion of all the deaths. We concluded that diarrhea and AR1 continue to be the most important reasons for utilization of pediatric emergency service at a primary as well as a tertiary care hospital.