Background/Aim: Paediatric heart failure is a condition that continues to present challenges in management in our environment especially in its  treatment and outcomes hence the aim of this study.Materials and Methods: A retrospective analysis of the case notes of all children who were diagnosed and managed for heart failure from January  2019 – October 2021 was undertaken. Data obtained included age, sex, presenting features, primary diagnosis, treatment modalities, duration ofhospital stay and outcomes.Results: A total of 2226 children were admitted over the study period with 67 children diagnosed with heart failure giving a prevalence rate of 3%  although only 47 case notes could be retrieved giving a case retrieval rate of 70%. There were 26 (55.3%) males and 21 (44.7%) females (M:F ratio1.2: 1). Mean age of patients was 32.6 months (±52.23) with 28 (59.6%) of them being infants. Bronchopneumonia was the commonest cause of heart  failure 31(65.9%) either singly or in combination with acyanotic congenital heart disease followed by severe anaemia in 14 (29.8%). Average duration  of hospital stay was 6.9days (±5.08) and average cost of admission was N13,266. Twenty-three patients were discharged (48.9%), while 10  (21.3%) left against medical advice, 2 absconded (4.3%) while 12 (25.3%) died.Conclusion: Heart failure remains an important cause of morbidity and mortality in children in our environment arising from largely preventable  causes. Urgent steps such as patient care giver education, immunization and screening for congenital heart disease are needed to reduce its effect  on children in our environment.