Purpose Slipped capital femoral epiphysis (SCFE) is an ado- lescent hip condition with a high risk of complication. The purpose of this study was to evaluate trends in treatment us- ing a prospectively collected paediatric nationally represent- ative database. Methods A total of 9034 patients undergoing treatment for idiopathic SCFE were selected by querying the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database for the years 1997, 2000, 2003, 2006, 2009 and 2012. The selected patients were separated based on operative approach and these cohorts were analyzed based on temporal and categor- ical differences in operative approach, patient demographics and clinical characteristics. Univariate and multivariate anal- yses were used when appropriate and the Mantel-Haenszel test for trend was used in temporal analysis. Results Overall SCFE procedures have decreased 27.5% (p < 0.001). Closed procedures have decreased 28.5% (p < 0.001), while open procedures have decreased 44.8% (p < 0.001). Bilateral closed procedures have increased 7.2% (p < 0.001). The ratio of open to closed procedures decreased in patients aged nine to 12 years and increased in patients aged 13 to 16 years (p < 0.001). Conclusion Here we report age stratified trends in treatment for idiopathic SCFE using nationally representative data and show an overall decrease in admissions and procedures over time. Level of Evidence Level III, retrospective comparison study.