Objective: Children who self-harm are at high risk for suicide attempts later in life, yet little is known about clinical profiles of young children who self-harm. The primary aim of this study is to characterize clinical profiles associated with self-harm in pre-adolescent children to inform risk recognition and prevention efforts. Method: A retrospective population-based cohort analysis of children aged 5-11 years who presented with self-harm in a medical setting from 2010-2020 (N=878) was conducted using Ohio Medicaid data. Children were followed for one year after the initial self-harm event to determine subsequent self-harm events. Results: Of the 878 children with initial self-harm, 116 children (13%) self-harmed again within the following year. Latent class analyses revealed three distinct clinical profiles. Children in class 1 tended to be male, typically presented in mental health settings with both externalizing and internalizing disorders, and commonly reported suicidal ideation. Children in class 2 were largely female, presented with internalizing disorders, and often expressed suicidal ideation. Children in class 2 were less likely than those in class 1 to have a history of mental health treatment but were equally at risk for more lethal self-harm and repetitive self-harming behaviors. Children in class 3 tended to be younger and from non-metropolitan areas, with fewer known mental health conditions. Conclusion: Study findings show children who self-harm have distinct clinical profiles that are associated with elevated risk for future self-harm. Findings underscore the importance of comprehensive risk assessment that guides clinical decision making for young children who self-harm.