BACKGROUND: Hoarseness in school-aged children may affect their educational achievement and interfere with their communication and social skills development. The global prevalence of hoarseness in school-aged children ranges between 6% and 23%. OBJECTIVE: Measure the prevalence of hoarseness among school-aged children and identify its associated factors. DESIGN: Cross-sectional questionnaire-based survey. SETTING: Randomly selected primary and early childhood schools in Saudi Arabia. PATIENTS AND METHODS: Data were collected using a questionnaire completed by the children’s parents, which included sociodemographic aspects, health and related comorbidities, history of frequent crying during, history of letter pronunciation problems and stuttering, history of vocal fold surgery, the Reflux Symptom Index (RSI), and Children’s Voice Handicap Index-10 for parents (CVHI-10-P). MAIN OUTCOME MEASURES: Determinants of hoarseness were investigated using the chi-square test, Fisher exact test, and adjusted and unadjusted logistic regression models SAMPLE SIZE: 428 children RESULTS: The mean age of the study children was 9.05 ± 2.15 years, of whom 69.40% were male. The rate of hoarseness in the participants was 7.5%, 9.90% were female and 6.40% were male. Hoarseness was found to be significantly associated with a history of excessive crying in infancy (12.24%, x2=7.54, p=0.006), letter pronunciation issues, especially ‘R’ and ‘S’ (13.56%, x2=8.71, p=0.003), stuttering (16.39%, x2=8.08, p=0.004), and those with a previous history of hoarseness (p=0.023). In addition, having symptoms of gastrointestinal reflux increased the risk of hoarseness by four times (OR=4.77, 95% CI= 2.171, 10.51) after adjustment for age and gender. CONCLUSIONS: Hoarseness in children may be underestimated as it may reflect the presence of speech problems (i.e., letter articulation and stuttering) in addition to the presence of laryngopharyngeal reflux. Hoarseness was assumed on the basis of parental complaints. Therefore, further research with diagnosis based on clinical assessment is needed to understand the magnitude of the hoarseness and its consequences