BACKGROUND: Reports on delays to National Health Service (NHS) surgical care have been widespread during and after the pandemic, however the impact on paediatric surgery is poorly described. METHODS: This retrospective observational cohort study used NHS hospital data in England for children aged <18 yr undergoing surgery over an 8-yr period from 1 April 2015 to 31 December 2020, with supplementary data until March 2023. The primary outcome was in-hospital mortality within 90 days after surgery. The secondary outcome was hospital stay. We report trends in annual surgical procedure volume and mortality. Frequencies presented as n (%). RESULTS: We identified 36 605 870 surgical procedures, between 1 April 2015 and 31 December 2020, of which 1 846 965 (5.0%) were for children. A total of 759 083/1 846 965 (41.1%) patients were female and 313 981 (17.0%) were from minority ethnic groups. There were 41 018/1 846 965 (2.2%) procedures among neonates, 93 872 (5.1%) for children aged 28 days to 1 yr, 532 828 (28.8%) for years 1-5, 502 971 (27.2%) for years 5-12, 361 176 (19.6%) for years 12-15, and 315 100 (17.1%) for years 15-17. Median hospital stay was 1 (0-1) day. There were 6 573/1 846 965 (0.36%) in-hospital deaths within 90 days after surgery, and a trend for increasing mortality risk between 2015 and 2020 (P<0.05). The average annual number of procedures before the pandemic (2015-19) was 340 596, decreasing to 266 049 in 2023 (22% reduction in volume). CONCLUSIONS: We report the trends in paediatric surgical volume and assocaited mortality for an entire healthcare system over eight years inlcuding during the COVID-19 pandemic. One in 14 surgical procedures were performed on children, with substantially lower mortality risk than adults.