Letter to the Editor, Journal of the American Academy of Child and Adolescent Psychiatry titled: "Stark Discrepancy in Pediatric Bipolar Diagnoses Between the US and UK/Australia". Commenting on the 70-fold difference in diagnostic rates for inpatients for the diagnosis of bipolar disorder between the USA and UK as described in the article by James et al. (2014). The difference is even greater for much younger age groups. Letter notes that Australian diagnosis rates for children would be much closer to UK than USA rates and also that surveys of child and adolescent psychiatrists in Australia and New Zealand, debate at the British child and adolescent psychiatry conference and the British NICE guidelines for bipolar disorder all show that majority opinion of British and Australian and New Zealand child psychiatrists is overwhelmingly conservative compared to US colleagues.