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Objective: To describe the frequency and factors related to mortality in children with Rocky Mountain fever spotted (RMSF) treated for 14 years at the Hospital Infantil del estado de Sonora. Material and methods: This is a retrospective cohort of 203 children, treated between 2003 and 2016. Clinical and laboratory data were compared between patients who died and those who survived. Chi-square and Student's t were used for comparison between groups; a p value <0.05 was considered statistically significant. Results: The overall mortality was 26.6%, in the period 2003-2008 happened the highest number of deaths, up to 66% in one year. In recent years, mortality has decreased to 14.3%. Statistically significant clinical features of poor prognosis were: edema of wrists, vasculitis, abdominal pain, renal failure and elevation of transaminases (SGOT and TGP). In recent years, the time of antibiotic initiation has decreased, but it has not been achieved on average ≤ 5 days. Conclusions: In children with RMSF, in this 14-year experience, an important decrease in mortality has been observed; however, more efforts should be made to achieve mortality between 3 and 7%, as has already been reported. [ABSTRACT FROM AUTHOR]