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Introduction: Background: Acute febrile thrombocytopenia is a commonly encountered entity in hospitalized patients. The usual etiology in tropical countries is an infection, though the common etiological agents will vary depending upon the region and season. Accurate and early diagnosis, though challenging at times, is important as timely institution of appropriate treatment may be life-saving. This study was planned to evaluate the clinical and etiological profile of pediatric patients admitted with acute febrile thrombocytopenia and to assess their complications and outcome. Patients and Methods: A retrospective study of hospital records of 118 patients with acute febrile thrombocytopenia was carried out. Their clinical findings, investigations and outcome were recorded and analyzed. Observations: An etiological diagnosis could be made in 81% patients. The most common etiology was scrub typhus (44%) followed by dengue fever (11%). Lower platelet counts were associated with a higher risk of complications like shock, acute kidney injury, encephalopathy and bleeding manifestations. Of all enrolled patients, 108 recovered and were discharged while 7 patients died and 3 left against medical advice. Conclusion: Infectious illnesses are commonest causes of acute febrile thrombocytopenia. Knowing the common etiological profile in a particular region and season will help in timely institution of appropriate empiric therapy to reduce morbidity and mortality from the condition. [ABSTRACT FROM AUTHOR]