Background: Scrub typhus is an important differential cause of acute undifferentiated febrile illness in the pediatric age-group. Diagnosis of scrub typhus is made by evaluating a child's history of exposure, clinical spectrum, and results of serologic testing. A high degree of clinical suspicion leading to early diagnosis and timely intervention has greatly reduced mortality due to various associated complications. This study aimed to study the epidemiological profile and outcome predictors for scrub typhus in admitted children in a tertiary care academic hospital in the Indian sub-Himalayan region. Methods: It was a cross-sectional study enrolling children aged 1 month to 18 years, diagnosed with scrub typhus based on IgM ELISA between January 2019 and December 2021. Detailed history, clinical examination findings, laboratory profile, complications, and outcomes were recorded and analyzed accordingly. Results: A total of 82 children were enrolled with 63.4% belonging to the 11–18 years age-group. High admission rates were observed in the months of May to August and September to December. Common presenting symptoms were fever (100%), nausea/vomiting (35.4%), headache (25.6%), shortness of breath (25.6%), pain abdomen (18.3%), and altered sensorium (9.8%); while classical eschar was seen in only 3.7% children. On examination, children had generalized lymphadenopathy, hepatosplenomegaly, hypotension, ascites, periorbital edema, maculopapular rash, and meningeal signs. The most common associated complications were septic shock, acute respiratory distress syndrome (ARDS), myocarditis, meningoencephalitis, and multiple organ dysfunction syndrome (MODS). The median duration of defervescence after starting antimicrobial therapy was 4 days. Children presenting with shock, ARDS, MODS, and meningoencephalitis had a statistically significant unfavorable outcome. Conclusion: Pediatric scrub typhus is a common infection in sub-Himalayan terrain. Physicians should be sensitized regarding symptoms, signs, and risk factors of scrub typhus. All cases of febrile illness should be evaluated for scrub typhus. As early detection and timely management lead to a higher recovery rate and prevention of complications; the present study would help clinicians identify severe cases and manage them accordingly.