Background Human immunodeficiency virus (HIV) positive status disclosure is an essential component of pediatric care and long-term disease management. However, pediatric HIV disclosure is a complex and understudied public health concern. This study aimed to assess the pediatric HIV-positive disclosure status and associated factors among caregivers. Method A facility-based cross-sectional study was done among 375 caregivers of HIV-positive children in selected facilities from March 1 to April 30, 2022. Data was collected through in-person interviews using a carefully designed questionnaire that had been tested beforehand. Study participants were randomly selected from the anti-retroviral therapy (ART) logbook using a lottery method as the sampling frame. The data collected was inputted into Epidata version 3.02 and then transferred to SPSS version 23 for analysis. The findings were displayed through tables, graphs, charts, and written descriptions. Statistical analyses using different models were performed to examine the data. The association of variables was declared at 95%CI and p-value <0.05 and the strength of association was determined using the adjusted odds ratio (AOR). Result Out of 371 participants, 98.9% replied to the survey. Forty-one point eight percent of caregivers told them about their HIV-positive children's status. Caregivers/parents' discussions with health care providers about disclosure [AOR 2.171, 95% CI [1.199, 3.931]], child duration on ART [AOR 1.633, 95% CI [1.013, 2.631]], and child stigmatization [AOR 2.103, 95% CI [1.361, 3.250]] were significantly associated with pediatric HIV positive status disclosure. Conclusion The rate of disclosing pediatric HIV-positive status was lower compared to other studies in Ethiopia. Caregivers who talked to healthcare providers, children on ART for a longer time, and caregivers not fearing stigma for their child were more likely to disclose pediatric HIV-positive status. Facility management and healthcare providers should focus on improving the disclosure of pediatric HIV-positive status.