Background: Relatively little information is available about the characteristics and long-term outcome of children and adolescents aged under 15 years who present to general hospitals because of deliberate self-harm (DSH). Method: Information was collected on 710 consecutive under-15-year-olds presenting to a general hospital in central England with DSH over a 26-year period (1978-2003). Outcome in terms of death was investigated from national statistics in 464 cases presenting during the first 20 years of the study. Results: Most individuals were aged 12-14 years. In this age group the female:male ratio was 6.5:1. Nearly all (680/710, 95.8%) had taken overdoses, over half of these episodes involving paracetamol (acetaminophen). Few had a history of prior (7.7%) or current psychiatric treatment (7.7%), although a quarter (150/559, 26.8%) had a history of previous DSH. Suicidal intent was usually low. The most frequent problems were difficulties in relationships with family members (77.3%) and with friends (38.9%), and school/study problems (37.9%). The long-term risk of suicide was low, 1.1% (N = 5) having died by probable suicide after a mean follow-up period of 11 years 2 months. Conclusions: DSH in children and young adolescents is usually related to life problems, is generally of low suicidal intent, and is associated with a relatively low long-term risk of suicide.