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Objectives: To describe the prevalence of pediatric acute respiratory distress syndrome (pARDS) and the characteristics of children with pARDS in South African PICUs., Design: Observational multicenter, cross-sectional point-prevalence study., Setting: Eight PICUs in four South African provinces., Patients: All children beyond the neonatal period and under 18 years of age admitted to participating PICUs., Interventions: None., Measurements and Main Results: Clinical and demographic data were prospectively collected on a single day of each month, from February to July 2022, using a centralized database. Cases with or at risk of pARDS were identified using the 2015 Pediatric Acute Lung Injury Consensus Conference criteria. Prevalence was calculated as the number of children meeting pARDS criteria/the total number of children admitted to PICU at the same time points. Three hundred ten patients were present in the PICU on study days: 166 (53.5%) male, median (interquartile range [IQR]) age 9.8 (3.1-32.9) months, and 195 (62.9%) invasively mechanically ventilated. Seventy-one (22.9%) patients were classified as being "at risk" of pARDS and 95 patients (prevalence 30.6%; 95% CI, 24.7-37.5%) fulfilled pARDS case criteria, with severity classified as mild (58.2%), moderate (25.3%), and severe (17.6%). Median (IQR) admission Pediatric Index of Mortality 3 risk of mortality in patients with and without pARDS was 5.6 (3.4-12.1) % versus 3.9 (1.0-8.2) % ( p = 0.002). Diagnostic categories differed between pARDS and non-pARDS groups ( p = 0.002), with no difference in age, sex, or presence of comorbidities. On multivariable logistic regression, increasing admission risk of mortality (adjusted odds ratio [aOR] 1.02; 95% CI, 1.00-1.04; p = 0.04) and being admitted with a respiratory condition (aOR 2.64; 95% CI, 1.27-5.48; p = 0.01) were independently associated with an increased likelihood of having pARDS., Conclusions: The 30.6% prevalence of pARDS in South Africa is substantially higher than reports from other sociogeographical regions, highlighting the need for further research in this setting., Competing Interests: Dr. Morrow’s institution received funding from the Society of Critical Care Medicine, the National Research Foundation of South Africa, and the Critical Care Society of Southern Africa; she received funding from the European Cystic Fibrosis Society and Brazilian Physiotherapy Association. Drs. Solomon and Khan received funding from the Critical Care Society of Southern Africa. Dr. Solomon received funding from ANN LAKE Publications. Dr. Naidoo received funding from Mbuso Medical, Fresenius Kabi, and Nutricia. Dr. Argent received funding for travel, accommodation, and registration to attend a number of conferences as an invited guest speaker and for providing expert witness evidence to a number of medicolegal cases. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)