Hypertension in children is a growing health concern with long-term risks of cardiovascular morbidity and progression to chronic kidney disease (CKD). Accurate diagnosis is complicated by in-office blood pressure (BP) variability, where situational anxiety often produces elevated readings that normalize outside the clinic, a phenomenon known as white coat hypertension (WCH). Ambulatory blood pressure monitoring (ABPM), the gold standard endorsed by the American Academy of Pediatrics, provides 24-hour data on diurnal variation, nocturnal dipping, and mean arterial pressure, providing more reliable diagnosis. We retrospectively reviewed 522 ABPM studies performed at the Children’s Hospital of Philadelphia, finding that 43.9% (n=229) of patients referred for elevated blood pressure were ultimately diagnosed with WCH. Patients with WCH were younger (p<0.001), more often female (p<0.001), and more likely to be White (p=0.006)., while sustained hypertension was more common in older, male, and Black patients. Pre-referral systolic BP ≥120 mmHg and diastolic BP ≥80 mmHg were significantly associated with sustained hypertension, while family history of hypertension was prevalent across both groups. These findings suggest that incorporating demographic predictors and standardized pre-referral BP assessments may reduce unnecessary nephrology visits. Future analyses will also determine best practice recommendations for the performance of an ABPM.