Recent studies have revealed increasingly worse and more complex mental health conditions in young people, which is reflected in a growing trend in emergency room (ER) visits for acute psychopathological symptoms (APSs). This phenomenon has become exacerbated in recent decades, with a peak in the post-pandemic period. To better characterize the phenomenon, we investigated the change in the rate and type of ER counseling requests provided at the Child Neuropsychiatry Unit of the University Hospital of Bari, Italy over the period between 2019 and 2023 for subjects younger than 18 years old. For this purpose, we retrospectively analyzed a total number of 1073 urgent consultation reports retrieved through the reporting computerized operating system of our hospital. The distribution of the counseling requests provided for APSs and, among these, the distribution of the numbers of APSs and of the male: female ratio were significantly different over the years, with an increasing linear trend identified for APSs ( = 3.095 × 10), the average number of APSs ( = 3.598 × 10), and female gender prevalence ( = 0.03908), as well as for the patients with a history of psychotropic drug assumption ( = 0.0006319). A significant change in the number of urgent counseling requests received for eating disorders ( = 0.0007408), depression ( = 7.92 × 10), somatization ( = 4.03 × 10), self-harm (SA) ( = 1.358 × 10), and non-suicidal self-injury (NSSI) ( = 8.965 × 10) was found, with a significant increasing trend for anxiety ( = 0.0444), depression ( = 8.06 × 10), somatization ( = 0.004616), SA ( = 3.998 × 10), and NSSI ( = 5.074 × 10). The findings of our study support the hypothesis of an alarming progressive worsening of the mental health of children and adolescents, with an overlapping effect of the pandemic exacerbating the process.