Pediatric populations are highly vulnerable to various diseases and are at risk of irrational prescribing practices, which can impact treatment outcomes and contribute to increased healthcare costs. Knowledge of disease, prescribing patterns, and knowledge of drug administration help to promote rational drug use in pediatric care. To assess the prevalence of common diseases and prescribing patterns in the Pediatric outpatient department of Kankai Nagar Hospital. A 1-month cross-sectional study was conducted on 245 pediatric patients at Kankai Nagar Hospital. Random sampling was used, and data were collected from prescriptions and patient-caregiver interviews. Descriptive statistics were used to evaluate prescribing trends, and costs were calculated to assess economic implications. Among the patients, 60% were male, with upper respiratory tract infections being the most common diagnosis (26.5%). The average number of drugs per encounter was 3.08, higher than the WHO standard, suggesting polypharmacy risks. NSAIDs (19.81%) and antibiotics (17.43%) were the most commonly prescribed drugs. The average cost per prescription was NPR 456.23, while antibiotics averaged NPR 159.56. Only 23.38% of caregivers had complete knowledge of correct dosages. The study reveals acceptable prescribing patterns but indicates prevalent polypharmacy, with reliance on NSAIDs and antibiotics and limited caregiver knowledge of drug use. Addressing these issues through caregiver education, policy changes, and clinical pharmacy integration could enhance rational drug use and improve pediatric healthcare outcomes.