Aim:To investigate parental help-seeking patterns prior to referral to outpatient child and adolescent mental health services (CAMHS), and whether type of symptoms or duration of mental health problems prior to referral influence help-seeking.Setting:Child mental health services in Denmark involve several sectors collaborating based on stepped-care principles. Access to CAMHS is free of charge but requires a formal referral.Methods:In this cross-sectional observational study, parents of 250 children were interviewed about pathways to outpatient CAMHS using the Children?s Services Interview.Results:The median parent-reported duration of mental health problems prior to referral to CAMHS was 6.0 (IQR 3.4?8.5) years for children referred for neurodevelopmental disorders compared to 2.8 (IQR 1.0?6.5) years for children referred for emotional disorders. Educational services were the first help-seeking contact for the majority (57.5%) but referrals to CAMHS were most frequently from healthcare services (56.4%), predominantly general practitioners. Educational services played a greater part in help-seeking pathways for children referred for neurodevelopmental disorders.Conclusion:The majority of children referred to CAMHS have mental health problems for years before referral. The delay in time-to-referral was most pronounced for children referred for neurodevelopmental disorders. Help-seeking pathways differ by symptom duration and type of symptoms.