OBJECTIVE To examine the association of dexamethasone prescription with AKI among hospitalized children in China. METHOD Children aged 1 to 18 years who were hospitalized for at least two days between January 1 and December 31, 2022 were included in this retrospective cohort study. Patients without available serum creatinine (Scr) tests or with severe renal impairment on admission were excluded. Baseline characteristics were balanced using inverse probability weighting (IPW) based on propensity scores. Multifactorial logistic regression was used to assess the association between the use of dexamethasone and the risk of AKI. Subgroup analyses were performed based on all covariates. Sensitivity analyses was performed by propensity score matching. RESULTS A total of 1,978 patients met the inclusion criteria, comprising 685 dexamethasone-exposed patients (96 AKI events, 14.0%) and 1,282 non-exposed patients (84 AKI events, 6.6%), yielding an overall AKI incidence rate of 6.6 events per 1,000 person-days. The IPW-adjusted multivariate logistic regression revealed that dexamethasone was an independent protective factor for AKI ( OR 0.47, 95% CI 0.32–0.69, P<0.01). A decreased risk of AKI was associated with male sex, younger age, low baseline Scr, diuretic use, and absence of comorbid fever or pulmonary infection (P<0.05). Sensitivity analyses suggested that dexamethasone may reduce the risk of AKI (Adjusted OR 0.66, 95% CI 0.37–1.17, P = 0.15). CONCLUSION Dexamethasone may be associated with decreased risk of AKI in hospitalized children. However, large-scale prospective studies are needed to further examine the association between dexamethasone and the risk of AKI in children.