Background: Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction. It is major cause of morbidity and mortality in developing countries of the world. Objective: The objective of this study was assessment of treatment outcome and its associated factors of pediatric, aged 1 month to 14 years, tetanus patients admitted to Comprehensive Specialized Hospitals in amhara region, Ethiopia from June 1, 2017 to June 1, 2020. Method: Institution based cross sectional study was conducted in medical records of 41 patients who fulfilled the eligibility criteria from about 5 comprehensive specialized hospitals in Amhara region. Tetanus is rare disease but clinically significant, so all charts were our study populations. Data collected by checklist was entered, cleaned and analyzed by SPSS statistical software version 23. Descriptive statistics was carried out. Binary logistic regression was used to assess the associated factors for poor treatment outcome of patients. P value <0.05 was considered as statistically significant. Result: from a total of 41 patients the case fatality rate of tetanus is found to be 34.1%. The majority, 33(80.5%) were males. The majority 33 (80.5%) of patients were aged above 5 years. Most of the patients were from rural area 30(73.2%). Sex (p value =0.493), age (p value =0.553) and address (p value =0.595) of the patients had no association with poor treatment outcome. Presence of complications has statistically significant (p value=0.04) association with poor treatment outcome of pediatric tetanus patients than patients without complications. Conclusion: This study showed high case fatality of tetanus (34.1%). Presence of complications had significant association with poor treatment outcome. Early detection and appropriate management of complications is recommended to decrease the case fatality rate of tetanus. Keyword; Pediatrics, tetanus, locks jaw, treatment outcome,