ABSTRACT Background: Hospital-acquired infections occur worldwide and affect both developed and resource-poor countries. Certain patients are at increased risk because of the severity and possible immunosuppressive nature of their illness, and their need for invasive monitoring and life support equipment. Objectives: This study is aimed to determine the incidence and risk factors of hospital-acquired infections among admitted Pediatrics patients in Tibebe Ghion specialized Hospital in 2022. Methods: A hospital-based prospective follow-up study was conducted from May1- August 1 2022 among pediatrics age group patients in Tibebe Ghion Specialized Hospital. All pediatrics patients admitted in (Pediatrics intensive care unit, Neonatal intensive care unit and General Ward) during the study period were included in the study. Data was collected through a structured checklist using an individual patient chart investigation approach after verbal assent was taken and data was coded and entered using Epinfo7 statistical software and exported to SPSS version 25 for analysis. Descriptive statistics and logistic regression were computed. Odds ratio with 95% confidence interval was computed to assess the presence and degree of association between dependent and independent variables by using multivariable logistic regression analysis. Result: A total of 591 Pediatric patients were followed for 5805 patient days. The median age of the patients was 1.8 months. The incidence rate of hospital acquired infection was 17.4 per 1000 Pediatric days of follow- up; while the overall cumulative incidence was 17.1 % over 3 months. Children who stayed greater than 8 days in the hospital (median day) (AOR: 28.1, 95% CI 9.71-81.38), children with underlying disease conditions (AOR: 4.93, 95% CI 2.44 to 9.97) and children with invasive medical device (AOR= 9.4, 95% CI: 5.04-17.68) had higher risks of developing HAIs. The most common type of hospital acquired infection was hospital acquired pneumonia and the most common etiologic agents were CONS & Klebsiella pneumoniae. Conclusion& recommendation: The overall cumulative incidence of HAIs was 17.1 per 100 admitted children. Length of stay in the hospital, underlying health conditions and presence of invasive medical devices were found to be important factors associated with increased risk of hospital acquired infection. Therefore the hospital management and clinicians should give attention to patients with underlying chronic medical condition for the prevention and control of hospital-acquired