Background: Malnutrition in children is a major problem in developing nations like India. Undernutrition among children < 5 years is a signicant contributor to the global disease burden and is a major cause of child mortality worldwide. Despite of signicant economic improvement of India, prevalence of malnutrition specically severe acute malnutrition (SAM) is signicantly high. Objectives: To study the clinical prole, risk factors and complications of severe acute malnutrition in children aged between 6 months to 5 years old admitted in a tertiary care hospital. Methods: A hospital based cross sectional observational study of 100 patients admitted in the Pediatric ward at Gauhati Medical College and Hospital, Guwahati, Assam from 1st June 2021 to 31st May 2022 within the age group of 6 months to 5 years with features of SAM. Results: In the present study, most of the cases were of 6 months to 2 years (62%) with male predominance (56%). 92% patients were from rural area, 71% belongs to lower socio-economic status, 68% family were of large size, 40% cases were given prelactal feed and 74% were deprived of exclusive breast feeding for 6 months. In this study, presenting symptoms were fever (72%), cough and running nose (52%), loose stool (40%), vomiting (42%), anorexia (34%). In the present study, common co morbidities were nutritional anaemia (82%), diarrhoea (40%), pneumonia (36%), vit D deciency (32%), UTI (28%), Sepsis (18%), hypokalaemia (15%), hypoglycaemia (14%) and vit Adeciency (xerophthalmia) (8%). Conclusion: From the present study, It was observed that large family size, maternal illiteracy, inadequate immunization, lack of exclusive breast feeding etc are important risk factors for SAM. If necessary, measures are taken against these risk factors we can prevent SAM among children