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Background: Motivation for the study. There are few studies describing the variation of COVID-19-associated multisystem inflammatory syndrome (MIS-C) in Peru across pandemic waves., Background: Main findings. Cases of MIS-C decreased during the first three years of the pandemic, with higher frequency in the second wave with clinical features similar to Kawasaki disease., Background: Implications. MIS-C is a post-infectious complication of SARS-CoV-2. Its diagnostic suspicion is important weeks after peak infections, especially in children who have not yet received COVID-19 vaccines., Background: This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.