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Introduction: Public awareness of the COVID-19 pandemic has resulted in a reduction in healthcare utilisation for other diseases. Understanding how the COVID-19 pandemic affects hospital admissions and the disease patterns is crucial for proper triaging and planning of health resources in future pandemics. Aim: To compare the clinical spectrum of paediatric inpatients in the post-COVID-19, pre-COVID-19 and during COVID-19 pandemic periods in a tertiary level teaching centre. Materials and Methods: This ambispective study was conducted at the Paediatrics Department of SAT, Govt. Medical College, Thiruvananthapuram, Kerala, India. The analysis included all cases hospitalised from April 2019 to March 2022, with the data divided into three time periods. The discharge diagnoses of all cases admitted during the study period were coded according to the ICD-10 criteria and included in the analysis. Differences in admissions, disease patterns, and ICU admissions during the three time periods (pre-COVID-19, post-COVID-19, and during COVID-19) were compared using oneway ANOVA and Tukey's post-hoc test. Results: In the present study, ward admissions (p-value <0.001), respiratory infections (p-value 0.031), asthma (p-value 0.009), and chronic systemic diseases (p-value 0.018) decreased in the post-COVID-19 period compared to the pre-COVID-19 period, whereas ICU admissions (p-value 0.010) and Diabetic Ketoacidosis (DKA) (p-value 0.002) increased. When comparing COVID-19 and post-COVID-19 periods, there was an increase in ward admissions (p-value 0.01), respiratory infections (p-value 0.018), and diarrhoea (p-value 0.029), but a decrease in the proportion of ICU admissions (p-value 0.01). There was no significant difference in mortality among the three time periods. Conclusion: There was a significant difference in the clinical spectrum of paediatric inpatients. The significant decrease in admissions of chronic systemic diseases, which require regular follow-up for management changes, raises concerns about the potential impact on patient care. [ABSTRACT FROM AUTHOR]