Background: Data on the pathophysiology and clinical spectrum of COVID-19 in children are few. The dominant respiratory outcome of COVID-19 is arterial hypoxaemia. Arterial Blood Gas (ABG) analysis helps detect early acid base balance alternations. Acid–base imbalance hasn't been outlined well in children with COVID-19. Objective: The aim of the current study is to evaluate the blood gas levels as a reflection to the acid-base status among COVID19 children at admission and to detect the pattern of acid-base disorders. Patients and methods: A total of 62 children with positive nasopharyngeal swabs were assessed for ABG at the time of admission in ElMatria Teaching Hospital from February 1, 2021 to the end of July 2021. Results: Among the study subjects, 53% were males and 47% were female. Most affected age group was <2 years. 53% presented by GIT manifestation (fever, nausea, vomiting, diarrhea), 37% presented by respiratory manifestation (fever, cough, dyspnea). Most common ABG finding was hypoxemia in 90.3% (P<0.001). PH (potential hydrogen) of about 50% was within the normal range, while 37.1% had acidosis and 12.9% had alkalosis (P<0.001). Base deficit was significantly found in 53.4% (P=0.004), while lactic acid was only elevated in 32.3% (P=0.005). Conclusion: ABG should be evaluated in all COVID-19 patients at admission. Children may present with atypical COVID symptoms as diarrhea, and children may resist changes in acid-base balance.