ABSTRACT This study aimed to analyze the profile of hospitalizations and factors associated with the deaths of children and adolescents with severe acute respiratory infection (SARI) caused by SARS-CoV-2 nationwide. The study comprised 6,843 children and adolescents hospitalized in 2020 who tested positive for COVID-19, based on data from the Influenza Epidemiological Surveillance Information System. Sociodemographic and clinical profiles, hospitalization frequency, lethality and recovery rates were analyzed. The outcome was recovery or death. The 6,843 children and adolescents comprised 1.9% of SARI hospitalized cases (n = 563,051). Of these, 57.7% developed critical SARI and 90% survived. Comorbidities were present in 40.8%, especially asthma, immunodepression, and neurological and cardiovascular diseases. The main symptoms were fever, cough, dyspnea, respiratory distress, and low oxygen saturation. Among those with critical SARI, 91.4% died. There was a higher frequency of children, especially those under five years of age and of mixed ethnicity. The highest hospitalization frequency occurred in the Southeastern and Northeastern regions, the highest recovery rates in the Southeastern and Southern regions, and the highest lethality rates in the Northern and Northeastern regions. Deaths were associated with ages ranging from 12 to 19 and being under one year of age, living in the Northern and Northeastern regions, progression to critical SARI, and having immunosuppression and cardiovascular disease. In contrast, asthma was associated with lower death rates. The frequency of complications and mortality rates caused by SARS-Cov-2 in the pediatric population are relevant, as well as the severity of the epidemic in the social inequality context and the health services’ frailty. (SARI SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- nationwide 6843 6 843 6,84 202 COVID19, COVID19 COVID 19, COVID-19 System profiles analyzed 1 9 1.9 n 563,051. 563051 563,051 . 563 051 563,051) these 577 57 7 57.7 90 survived 408 40 8 40.8% immunodepression diseases fever cough dyspnea distress saturation 914 91 4 91.4 died ethnicity regions disease contrast SARSCov2 SARSCov Cov SARS-Cov- relevant services frailty SARS-CoV 684 84 6,8 20 COVID1 COVID-1 1. 56305 563,05 56 05 5 57. 40.8 91. SARS-Cov 68 6, COVID- 5630 563,0 0 40. 563,