Introduction: Nowadays, the death of children in the pediatric emergency unit is one of the most challenging problems in developing countries. Most death occurs due to preventable disease. Guidelines and studies showed most deaths occurred within 24 hours. However, these studies don’t show the exact time of death in the pediatric emergency before 24 hours. Objective: The aim of this study was to determine the time to death and its predictors in the pediatric emergency unit at Bahir Dar City, Public hospitals, Northwest Ethiopia 2022. Methods: Institutional-based prospective follow-up study was conducted on 434 children (from 29 day-14 years who were admitted in a pediatric emergency from May 13-June 13 in Bahir Dar city, public hospital, 2022. Systematic random sampling was used to select the sampling unit and the sample was taken for every other patient. The data collection was conducted by trained nurses by using a well-structured interviewer-based questionnaire and observational checklist. All the collected data were checked by the investigator for completeness and consistency. Variables with P-values< 0.2 in the bivariable analysis were fitted into the multivariable cox regression model. Finally, variables with p-values < 0.05 in the multi-variable Cox regression analysis were considered as significant predictors of time to death. Result: A total of 434 participants were included in the study. Of them, 62.9% of the children were females, And the median of time from admission to death was around 20 hours. Overall, the proportion of experiencing child death rate in the Bahir Dar City public Hospital was 3.9% 95% (CI:2.08, 5.74). This translates to 8 deaths per 1000 patients per 24 hours. Being an unvaccinated child (AHR = 5.7; 95% CI: (1.3–24)), Child age less than 1 year (AHR 6.9; 95%CI:(1-31)), Child had an injury (AHR=5;95%(CI:1.3-19) and caregiver who were unable to read and write (AHR=4.8; 95% CI (3.2-7.2) were statistically significant predictors of time-to-death. Conclusion and recommendation: Being unvaccinated child status, child age less than 1 year, caregiver educational level who were unable to read and write and child had injury were significantly associated predictors of children’s time-to-death. therefore, special attention should be given to these high-risk group patients. KEYWORDS: Time to death, pediatric emergency, Bahir Dar city.