Background The occiput is a common location for development of pressure ulcers in hospitalized infants and young children. However, risk factors associated with occurrence of the ulcers have not been fully described. Objective To identify factors associated with development of occipital pressure ulcers in acutely ill infants and children. Methods Charts of all patients with occipital pressure ulcers reported in a computerized safety event reporting system since its implementation in 2005 and of any patients with such ulcers recalled by members of the skin care special interest group were reviewed retrospectively. Results During a 4-year period, 60 cases of occipital pressure ulcers were identified: 40% stage I, 12% stage II, 30% unstageable, and 18% deep tissue Injury. The median age of the sample was 12 months. Among the patients, 86% were in the intensive care unit with cardiovascular or pulmonary problems. A total of 68% had comorbid conditions. Most of the patients were less than 1 year old; were critically ill, requiring high-risk therapies; and had multiple medical devices in place. Patients with the ulcers were commonly treated with mechanical ventilation (83%) and sedation (74%) and were described as agitated (42%). Many of these patients were receiving vasoactive medications (50%) and had vascular access devices in the neck that restricted head movement (45%). When documented, the median Braden Q score was 16. Conclusions Infants and children at risk for occipital pressure ulcers can be prospectively identified, allowing implementation of nursing interventions to prevent these ulcers.