Objectives To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.

Design Cross-sectional study by performing secondary analysis of 2010–2011 Iowa Child and Family Household Health Survey data.

Setting State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.

Patients/participants Among the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%.

Exposure/intervention Presence of a medical home.

Main outcome measures Child visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting.

Results Among children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child's health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary-care preventable ED visit.

Conclusions The majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.