Key PointsQuestionAre co-occurring pain, psychological, and sleep disturbance symptom trajectories associated with demographic characteristics of children and are symptom trajectories associated with nonroutine health care utilization during early adolescence?FindingsThis cohort study, including 11 473 children, used 9 symptom trajectories to classify participants in the Adolescent Brain Cognitive Development (ABCD) study cohort, most of whom clustered with asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children had moderate to high co-occurring symptom trajectories, but less than half of these reported nonroutine medical or mental health care use, with lower rates among Black, other race, and Hispanic children.MeaningThese findings suggest that there is a need for better recognition and equitable, prompt interventions to mitigate symptom persistence among children.