Introduction: Comprehensive dental care of early childhood caries (ECC) is often accomplished under general anesthesia (GA). General anesthesiaallows dental treatment to be performed under optimal conditions thus ensuring an ideal outcome. Failures of restorations after dental rehabilitationwill increase the risk for caries development. Few studies have been carried out to evaluate the restorative failure rate of dental treatment under GAamong children with ECC.Objective: To assess the failure rate of restorations for children with early childhood caries undergoing dental treatment under general anesthesia.Materials and methods: Dental records of healthy children diagnosed with early childhood caries (ECC), aged 3-6 years, and had dental treatmentunder general anesthesia were reviewed. Data regarding restorative failure was gathered from two groups of children according to recall period(group I after 6 months, and group II after 12 months).Results: The highest failure rate in group I related was to composite restorations (96.2%), followed by anterior glass ionomer (91.7%), posteriorglass ionomer (20%), stainless steel crown (SSC) (1%), and finally amalgam (0%). In group II the highest failure rate was related to compositerestorations (88.5%), anterior GIC (77.8%),posterior GIC (28.6%),amalgam (13%), and finally SSC (5.6%).In composite restorations, fracture inboth groups was the main cause of failure, group I (100.0%), and group II (87.0%), whereas, secondary caries was the second cause in group II(13.0%). In group (I), no amalgam failure was recorded, while in group (II) secondary caries was the main cause of amalgam failure (67.0%),followed by fracture (33.0%). In both groups, fracture of restorations, and secondary caries were the main causes of anterior GIC failure (100.0%),and posterior GIC failure (100.0%). Loss of retention was the main cause of SSCs failure in both groups (100.0%).Conclusion: Anterior restorations have a higher failure rate than posterior restorations. Factors affecting restoration failure significantly were:Unsupervised tooth brushing, and failure to conform to recall appointments.