Background: Severe acute malnutrition (SAM) is ubiquitous in India and cause of death for million numbers of children every year. Children with SAM have nine times higher risk of dying than well–nourished children. Therefore, an assessment of clinical profile of malnourished children can able to impart idea about responsible factors in SAM and facilitate its management. Objective: To evaluate the clinical profile of severely malnourished children admitted in pediatric ward of a Medical College. Materials and Method: A hospital based cross sectional observational study, carried out in the pediatric ward of B.J. Medical College, Pune from June 2008 to June 2009. Ethical clearance obtained from institutional ethical committee before commence the study. The study group comprised of 75 children aged 6 months to 6 years with Severe Malnutrition. To evaluate clinical profile of malnourished children history including present complaints, past history, birth history, family history and immunization status, dietary habit, socioeconomic status recorded. Data analyzed with SPSS (Statistical package of social sciences) version 20.0 and presented in terms of frequency and percentages. Results: The majority of cases (48%) was having both nutritional and non–nutritional causes as an underlying etiology for malnutrition. 60% cases had significant past history in the form of chronic illness, and 21.2% cases had significant family history  as  a  contributing  factor  to  malnutrition. Majority children suffer from chronic recurrent illnesses e.g. fever, respiratory symptoms and acute gastroenteritis and require hospitalizations. Even children had poor immunization coverage, faulty feeding practices. Conclusion: This study concluded that past medical history, family history, birth history, immunization, antenatal care, immunization schedule and socioeconomic status all are responsible factors in predilection of malnutrition.