Acute respiratory distress syndrome (ARDS) is one of the rapidly progressing disease contributing to high rate of morbidity and mortality. It causes fluid to leak into the lung making the oxygen difficult to get into the blood stream. Methodology: This study was carried out at a tertiary level pediatric multispecialty hospital. The study duration was for 14 months. A total of 30 children who were fulfilling the BERLINs criteria for ARDS were included in the study. Pao2/Fio2 ratio were noted and depending upon the BERLINs definition patient were classified into (mild/moderate/severe) type of ARDS. Result: In the present study (21/30)70% children had primary ARDS and 30 % (9/30) had secondary. Among the primary ARDS 63% had pneumonia, 6% had transfusion triggered injury and 3% had accidental hydrocarbon aspiration (kerosene poisoning). On scoring mortality risk by PRISM III, (16.6%) had score of less than 15 and 5/30 (83.3%) score of more than 15. 10% of the patients required noninvasive and 90% of children required invasive type of ventilation. Conclusion: Primary ARDS is the commonest etiology with pneumonia being the major cause. Conventional ventilation is the primary modality to maintain ventilatory status with few children requiring High Frequency Oscillatory therapy aiming at low tidal volume and higher PEEP.