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Background Despite the US population becoming increasingly diverse, gender and racial/ethnic disparities in academic paediatrics persist, limiting the provision of culturally effective care. Recent policy changes, including the US Supreme Court ruling against affirmative action, risk further exacerbating these disparities and impeding progress towards a more diverse healthcare workforce.Objective To examine trends in gender and race/ethnicity in academic paediatrics over 55 years, with a focus on identifying areas where representation remains limited.Methods A retrospective analysis of publicly available data from the Association of American Medical Colleges (AAMC) from 1966 to 2021 was conducted. Data on paediatric faculty members, categorised by gender, race and ethnicity, were analysed. Poisson regression models estimated annual growth rates and assessed trends in gender and racial/ethnic representation across academic ranks and department chairs.Results The paediatric workforce grew at an annual rate of 4.80% from 1966 to 2021. With a significantly higher growth rate compared with men (3.56%), women (6.43%) became the majority in the workforce by 2021. Racial/ethnic minoritised groups also showed significant growth. However, disparities persist in senior academic ranks and leadership positions, with men and White individuals still holding the majority of professor roles and department chair positions.Conclusions Despite progress in gender and racial/ethnic representation in academic paediatrics, disparities remain, especially in senior ranks and leadership roles. These findings highlight the ongoing need for efforts to promote diversity, equity, and inclusion in paediatric academic medicine, especially in light of recent policy changes that may impede such initiatives.