Abstract: OBJECTIVE To analyze the use and distribution characteristics of toxic traditional Chinese medicine decoction pieces in children's specialized hospital, and to provide data reference for the safe and rational use of toxic traditional Chinese medicine decoction pieces in clinical applications.METHODS According to the relevant legal documents, the prescription data of toxic traditional Chinese medicine decoction pieces in outpatients of Beijing Children's Hospital Affiliated to Capital Medical University from 2019 to 2021 were collected and arranged retrospectively, and made retrospective statistical analysis of their gender, age, clinical diagnosis, frequency of use, dosage and use of super pharmacopoeia dosage.RESULTS Among the 66 294 outpatient prescriptions of Chinese herbal pieces, 11 toxic Chinese herbal pieces were involved with 18 680 prescriptions, accounting for 28.18%. According to the statistics of age group, preschool and school-age children used the most toxic traditional Chinese medicine decoction pieces, and male children were more than female children. The number of prescriptions of oral toxic traditional Chinese medicine decoction pieces was more than that for external use. The top five toxic traditional Chinese medicine decoction pieces used frequently were fried Armenicacae Semen Amarum, salt Tribuli Fructus, fried Xanthii Fructus, Toosendan Fructus and Scorpio. There were different degrees of over dose use of 9 toxic traditional Chinese medicine decoction pieces, and the over dose problem of processed Euodiae Fructus prescription was the most prominent. There were 22 309 pieces of toxic traditional Chinese medicine. In a single prescription, more than one piece of toxic traditional Chinese medicine was used and 3 913 pieces of 2 or more toxic traditional Chinese medicine decoction pieces were used in combination. CONCLUSION Toxic traditional Chinese medicine decoction pieces are widely used in pediatric clinic, and it is reasonable. However, it is necessary to be aware of the potential risks of continuous use of toxic traditional Chinese medicine, use of super pharmacopoeia dosage and combination of toxic traditional Chinese medicine.