Background: Globally, HIV is still a major public health concern as it is a major contributor of the global disease burden among children and adults. Even though the efforts made to improve survival time of HIV-infected children have resulted in significant reductions in mortality rates among children, the presence of persistent and intolerably high numbers of child deaths shows that more work needs to be done to address the specific survival needs of children Objective: To assess survival time and its predictors among HIV infected children on antiretroviral therapy at Hawassa city public hospitals, Sidama region, Southern Ethiopia, 2023 Methods: A facility based retrospective cohort study was conducted in Adare general hospital and Hawassa university comprehensive specialized hospital among 261 children who had been on antiretroviral therapy from January 1st, 2010 to December 30, 2022. Data was collected by using ODK. The charts were reviewed from February to May, 2023. The collected data were exported to SPSS 26 and cleaned ,coded and then exported to STATA version 16 for statistical analysis. Descriptive statistics were used to describe the categorical variables A Kaplan Meier curve and long rank test were used to estimate the survival time and compare survival curves between variables. Multivariable Cox proportional hazards model was fitted to identify predictors of survival status and variables having p value < 0.05 were considered as statistically significant. Result: In this study, a total of 261 HIV children on ART were followed up with response rate of 93.4 for a total of 144 months, with a mean survival time of 133.3 months (95%CI= 128.8137.8). The overall mortality incidence rate in the cohort was 1.05/1000 child month observation. The overall Kaplan-Meir survival estimation curve showed that after last month of follow up, the survival probability of the child was 83.7%. In this study low hemoglobin level, poor adherence, Isoniazid prophylaxis, being underweight were statistically significant predictors of survival time (P <0.05). Conclusion and Recommendation: In this study, the estimated mean survival time was 133.3 months. Children with low hemoglobin level, who were underweight, not taking isoniazid ptophylaxis, and who had poor adherence were at higher risk of death. Therefore, concerned xi stakeholders should focus on above mentioned predictors of mortality and interventions should be taken to enhance survival of HIV infected children on antiretroviral therapy.