Background: Malnutrition is a general term and often refers to under nutrition resulting from inadequate consumption, poor absorption, or excessive loss of nutrients, but the term also encompasses over nutrition. Aim of the Study: Aim of the study was to find out the clinical profile and major co-morbidities among hospitalized children with severe acute malnutrition at a tertiary care hospital. Methods: A prospective observational study was conducted in the Department of Pediatrics, Khulna Medical College and Hospital, Khulna, Bangladesh, over one year from January 2019 to December 2019. Result: A total of 1810 children were enrolled and analyzed in this study. Table 1 shows the baseline data of our study. Most 59.67% of patients were from the age group 1-12 months, 588(32.49%) patients were from the age group 13-24 months, and 142(7.85%) patients were from the age group 25-59 months. Conclusion: Determinants of severe malnutrition include faulty feeding practices, ignorance about nutritional needs, repeated infections, large family size, and low socioeconomic status. The weight-height ratio is one of the best among the criteria for identifying SAM, and hence, every child should be screened adequately on presentation.