Introduction Acute respiratory failure (FRA) is an important cause of morbidity and mortality in pediatrics, it has a multifactorial origin. Additionally, there are few high-altitude studies in the pediatric population in Latin America. Objective: Calculate the incidence, analyze the causes, treatments, factors associated with the development, severity, mortality and burden of FRA disease in three hospitals in Bogota. Study design: It is a multicenter prospective cohort study. As eligibility criteria, those older than 1 month and younger than 18 years with respiratory distress. Those who develop FRA, will be follow-up at diagnosis, 48 hours after admission, at discharge, 30 and 60 days after discharge. Data collection period 03/2020-06/2021. Results: From the 197 recruited patients the incidence of FRA is 49%, 52% of the population is male, average age 3.7 years, mostly patients under 1 year. From those FRA, 68% have required hospitalization in the intensive care unit with a mean stay of 9.6 days. The most widely used ventilation device is the high-flow cannula (41%). Different etiological isolation methods have been used for viral and bacterial causes, including PCR for COVID-19 in 72% of the whole population, positive in 9% of the cases. So far with mortality secondary to FRA of 6%. Conclusions: Given the impact of FRA in the pediatric population, FARA is presented as an epidemiological study developed at a high altitude, with the purpose of contributing to scientific knowledge, and additionally related to the characterization of the pediatric population with COVID 19.