Introduction: Nepal's population includes 13 million children under 14. The infant mortality rate is 44.54/1000 live births and limited accessibility to medical care persists. This study aims to highlight the perceived scarcity and identify barriers in the delivery of pediatric critical care. Methods: Pediatric Universal Life Saving Effort, Inc (PULSE), a non profit organization collaborated with hospitals in Kathmandu by sending an online anonymous questionnaire in Survey monkey, via The Nepal Pediatric Society (NEPAS) to 250 members. We received and analyzed 65 responses. Results: The respondents were pediatric residents (34%) and pediatricians (66%). There are no physicians with pediatric critical care training. The PICU patients were taken care of by pediatricians (54%), general medicine (10%), anesthesia (13%), neonatologists (16%), and others (7%). The participants were from 18 teaching hospitals spread across Nepal. These centers offer training in nursing (90%), medicine (86.27%) and pediatric post graduate studies (78.4%). Resuscitation courses offered include NRP (45%), BLS (30%) and PALS (17%). The allocation of beds for critically-ill children varies from 1-4 (54.3%), 5-14 (23.5%) and more than 15 (8%). 80% reported having an intensive care unit although there are less then 25 PICU beds in the country. 20% reported having no monitoring capability. The case mix of patients included trauma (47.8%), burns (41.3%), post surgical (43.8%), congenital heart disease (67.39%) and cardiac surgery (21.7%). All institutions have oxygen by wall source or cylinders, but 40 % reported interruptions in continuous delivery. Conclusions: PICU beds are scarce in Nepal and significant disparities exists among institutions caring for children. This population is cared for in adults ICU's or elsewhere. A focused skill-based training and core pediatric critical care curriculum will improve knowledge, clinical skills and resource utilization. In addition reorganizing the infrastructure of pediatric critical care will reduce the high infant mortality rate.