Background: Despite abundant sunlight, Indian children frequently exhibit suboptimal vitamin D status. Evidence from rural tertiary pediatric settings remains limited. Methods: A hospital-based observational study was conducted among 110 inpatients (aged 1 month–<18 years) in Gujarat, India. Serum 25(OH)D was measured using chemiluminescent immunoassay and classified as deficient (<12 ng/mL), insufficient (12–20 ng/mL), or sufficient (>20 ng/mL). Associations of sufficiency with dietary pattern, recent supplementation, sun exposure, sun protection, skin type, and antiepileptic drug (AED) use were evaluated using chi-square or t-tests. Results: Vitamin D sufficiency was observed in 62.7% of children. Sufficiency was significantly lower in older children (p=0.003) but did not differ by sex (p=0.109). Dietary pattern (vegetarian/eggetarian vs non-vegetarian, p=0.007) and recent supplementation (p=0.027) were significantly associated with sufficiency, while sun-exposure hours, sun protection, skin type, and AED use were not (all p>0.05). Mean alkaline phosphatase levels did not differ between groups (p=0.302). Conclusions: Two-thirds of hospitalized children were vitamin D sufficient using a >20 ng/mL cut-off. Dietary factors and recent supplementation were major determinants of sufficiency, whereas sun-exposure proxies and ALP were not. These findings support continued emphasis on guideline-concordant supplementation and dietary fortification strategies in pediatric care.