Previous studies have documented worsening behavioral and emotional symptoms in children during the COVID-19 pandemic, although much focus has been on internalizing conditions with relatively short follow-up time. We examined a range of symptoms before and during the pandemic through mid-2021 in a primary care sample. Children 4-17 (n = 181) who completed emotional and behavioral assessments prior to the pandemic and then completed a follow-up assessment during the pandemic were included in our analyses. We examined changes in broad-based and clinical scales, including the Behavior Assessment System for Children and the Diagnostic and Statistical Manual of Mental Disorders, across the total sample and among subgroups using paired t-tests. Subgroups included sex, race, and ethnicity, and baseline internalizing, externalizing, and adaptive scores. Children without clinically significant elevations in internalizing, externalizing, and adaptive scores at baseline experienced worsening of symptoms in a greater number of areas than children with clinically significant elevations at baseline. Females and Black children tended to experience greater worsening of symptoms than males and White children, respectively. Our findings suggest worsening symptoms in children persisting one year into the pandemic, particularly for those without clinically significant symptoms at baseline.