Background: The first case of 2009 pandemic influenza A (H1N1) virus infection in India was reported in May, 2009 and in Saurashtra region in August, 2009. We describe the clinico-epidemiological characteristics of children who were hospitalized with 2009 influenza A (H1N1) infection in Saurashtra region. Methods: From September, 2009 to February, 2010, we observed 62 children infected with 2009 influenza A (H1N1) virus who were admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features of the disease were closely monitored. Results: Of 62 patients, median age was 2.5 years, and 56.5% were males. Median time of 5 days was observed from onset of illness to influenza A (H1N1) diagnosis, while median time of 7 days reported for hospital stay. All admitted patients received oseltamivir drug, but only 9.7% received it within 2 days of onset of illness. More than one fourth (29.0%) of admitted patients were expired. The most common symptoms were cough (69.4%), fever (61.3%), sore throat and shortness of breathing. Pneumonia was reported in 97.1% patients with chest radiography. Conclusion: We have demonstrated that infection related illness affects children with survival of 71% patients after antiviral treatment. The median time for virus detection with use of real-time RT-PCR is 5 days. Mortality reported high among children with radiological evidence of pneumonia.