Congenital heart disease (CHD) is one of the commonest causes of infant mortality rate in developing countries. Early detection, referral and treatment of infants and children with CHD contribute to the reduction in the infant mortality rate. There are differences in the prevalence and distribution in different parts of India. A study was conducted in a tertiary care Hospital to know the prevalence of CHD in this state. Aim of the Study: To study the prevalence, age and gender distribution and clinical spectrum of congenital heart disease (CHD) among pediatric patients attending outpatient department (OPD) of a tertiary care hospital in Kerala. Materials: A prospective cross sectional study was carried over 36 months on children aged from newborn to 12 years and 179 children with CHD were screened, included and analyzed. Infants/ children aged 0 to 12 years with symptoms of CHD, or suspicious of CHDs were included. After initial clinical examination and pulse oxymetry diagnoses were confirmed by detailed 2-D Echocardiography and color Doppler studies. Two dimensional and color Doppler echocardiography were done with Neonatal (12MHz) and Pediatric (8MHz) sector transducer. ASD with less than 4.0 mm diameter was not included as a CHD. If more than one lesion was observed, the defects which caused hemodynamic imbalance or which required immediate treatment were considered as the main CHD. Results: 1569 children were screened out of 18753 pediatric patients who attended the neonatal ICU, Pediatric medicine departments. Among