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BACKGROUND Increasing preconception paternal comorbidity has been associated with adverse pregnancy outcomes. However, whether the father's health impacts the child after birth is uncertain. OBJECTIVES In the present study, we examined the association of preconception paternal metabolic syndrome status with childhood emergency department (ED) visits and hospitalizations. MATERIALS AND METHODS This is a longitudinal cohort study of children (295,355 boys and 278,735 girls) born to linked pairs of fathers and mothers in the United States between 2009 to 2016 within the IBM MarketScan® Research database. Associations between paternal and maternal metabolic syndrome (MetS) component diagnoses and subsequent hospitalizations and emergency department visits for offspring within the first two years of life were determined. RESULTS 35.5% (203,617/574,090) of children had at least one emergency room visit and 6.1% (35,141/574,090) of children had an inpatient admission. After adjustment, the odds of inpatient admission and emergency department visits increased in a dose-dependent fashion among fathers with higher comorbidities. Similar trends were seen for emergency department visit utilization. DISCUSSION AND CONCLUSION Increasing paternal preconception comorbidity is associated with a higher risk that a child requires emergency department and inpatient care in the first years of life. An opportunity exists to engage men in preconception counseling to optimize theirs and their offspring's health. This article is protected by copyright. All rights reserved.