Objective: The present study was undertaken to study the spectrum of pandemic pediatric H1N1 viral infection in children attending to tertiary care center in Bangalore. Methods: Children who had an acute febrile respiratory illness were examined and suspected H1N1 infection cases were investigated with nasopharyngeal secretion swab and were managed according to guidelines for H1N1 infection. Patients found to be positive for H1N1-swine flu infection by RT-PCR were analyzed. Results: A total of 282 pediatric patients with suspected H1N1 infection were clinically screened. 10.8 % patients had confirmed H1N1 virus infection. 56.7 % were male patients, more than 93% of the cases occurred above the age of one years. Only 6.6% of cases were seen below the age of one year. Clinically all of them had influenza like illness, more than 90% patients had cough and fever. 6.7% of the patients had epistaxis, 13.3% had erythematous maculopapular skin rashes and 43.3% patients had pneumonia. 20% of the patients went into shock, 16.7% developed ARDS and 20% of patients required mechanical ventilation. 13.3% patients succumbed to the illness. Conclusion: The pediatric H1N1 infections presented initially with acute upper respiratory tract infection symptoms and signs. Children with H1N1 had high rate of complications and mortality. There were some atypical manifestations. There were no clinical features or laboratory findings which predicted worsening of illness. The timing of initiation of anti H1N1 drugs needs to be evaluated further to have maximum benefit from it.