Background: Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted. Objective: To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems. Participants and setting: Participants (N = 2198) were a sample of children ages 1–17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures. Method: Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs. Results: Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes.