Introduction: Within Manitoba, little is known about the current state of pediatric emergency department (ED) use or the state of provincial data collection. This study sought to gain a baseline understanding of pediatric ED use in Manitoba, including child demographics, visit characteristics, variation across the province, drivers of ED use, and data completeness. Methods: A retrospective cohort study was conducted using administrative data from the Manitoba Centre for Health Policy, and included all children aged 0-17 who presented to a Manitoba ED between 2011/12 and 2015/16, as identified from the Emergency Department Information System (EDIS), the National Ambulatory Care Reporting System (NACRS) and physician billing claims. Frequency of use was defined as single, intermediate (2-6 visits) and frequent (7+) and regional trends in child characteristics, ED use, acuity, presenting complaints, and discharge dispositions were observed. Ordinal logistic regression will be used to identify predictors of ED use. Results: Overall, we were able to capture 250,620 ED visits made by 172,306 children; data sources and completeness varied by year. Provincially, children under 5 years of age were the most frequent users of the ED, and use <1 year of age was highest in the North. We observed higher use among low-income children, particularly in rural mid and north, and few differences by sex. By year, the majority of children made single-use of the ED (64.48%), while fewer were classified as intermediate (34.40%) or frequent users (1.11%). Overall, the top presenting complaints were for fever (10.27%), limb complaint/trauma (7.48%), abdominal pain (5.75%), nausea and/or vomiting (4.53%) and shortness of breath (3.68%), with variation by triage level. In rural but not urban areas, mental health assessments were a top presenting complaint and primary reason for transfer to larger centres. Results of predictors of ED use are pending. Conclusion: Results from this study will provide important information about the predictors and variation of ED use by region and top causes for visit, enabling us to better tailor knowledge mobilization efforts and tool development to the local context. Identified gaps in data collection are important to address to advance our knowledge and delivery of pediatric emergency care at the provincial level.