Follow-up appointments and phone contact after discharge are important components of the emergency department (ED) encounter. We surveyed ED directors at hospitals with accredited pediatric residency programs to determine mechanisms for follow-up 1) to chart progression of illness (POI), 2) for positive laboratory or x-ray results, and 3) for specific illness such as child abuse, burns, and complex wounds. One hundred thirty-five of 207 program directors responded (65%). To follow POI, 54% of EDs use the ED itself, and 59% send patients to community physicians. Of those that use community physicians, 24% do not notify the physician to expect a follow-up visit, and 27% do not send a copy of the ED chart to a physician's office. To follow POI, 20% of EDs have no formal mechanism for telephone follow-up. Sixteen percent keep no record of phone contact. For follow-up of positive laboratory tests or x-rays, results are better; only 4 and 5%, respectively, do not keep records of phone contact. Eleven percent of EDs have no mechanism for follow-up of child abuse. Mechanisms for follow-up of children seen in the ED are variable. We have identified deficiencies in the following areas: 1) lack of communication with the physician to provide follow-up, 2) lack of documentation regarding subsequent patient contacts for POI and positive test results, and 3) lack of resources to follow victims of child abuse. These deficiencies have potential implications regarding optimal patient outcome.