BackgroundEarly Childhood Caries (ECC) continues to be the most common public health issue in developing countries.AimThe purpose of this study was to assess the prevalence of ECC in 0‐ to 3‐year‐old children from rural areas of South India, using the ICDAS.DesignA cross‐sectional study was carried out with 1486 children aged 0–3 years in South India. Two calibrated examiners performed the oral examinations using International Caries Detection and Assessment System (ICDAS) criteria. Data analysis involved the use of the new ICDAS epidemiological software tool.ResultsPrevalence of ECC in studied child population was 40.6%. Among the 604 children with ECC, only non‐cavitated teeth were present in 314 children, and only cavitated teeth were present in 84 children. The remaining 206 children had both cavitated and non‐cavitated teeth. Interesting lesion behavior was observed in 27 children, who had enamel lesions in mandibular canines only, in an otherwise sound dentition. On examining the teeth surfaces affected (n = 102,274), 50.3% had non‐cavitated surfaces and 49.7% had cavitated surfaces.ConclusionsThe results demonstrate the high prevalence of ECC in this population and the need to consider early diagnosis and specific preventive interventions. The authors of this study have also addressed their views about the use of ICDAS software tool.