Abstract: Delirium is an acute neuropsychiatric syndrome characterized by disturbances in attention, awareness, cognition, and perception that fluctuate over time. In pediatric intensive care units (PICUs), delirium has emerged as a significant complication affecting critically ill children and is associated with prolonged mechanical ventilation, increased hospital stay, higher healthcare costs, long-term cognitive impairment, and increased mortality. The multifactorial etiology of pediatric delirium includes critical illness, sedative exposure, sleep disruption, pain, environmental stressors, and underlying neurological vulnerabilities. Nurses play a pivotal role in the prevention, early recognition, and management of delirium because of their continuous bedside presence and close interaction with patients and families. Evidence increasingly supports non-pharmacological nursing interventions as the cornerstone of delirium prevention strategies in PICUs. These interventions encompass routine delirium screening, sleep promotion, family engagement, early mobilization, environmental modifications, pain management, optimization of sedation practices, and multidisciplinary collaboration. This review explores the epidemiology, pathophysiology, risk factors, assessment tools, and evidence-based nursing interventions for delirium prevention in pediatric intensive care settings. Emphasis is placed on nursing-led strategies that can reduce the incidence and severity of delirium while improving patient outcomes. Strengthening nurses' knowledge and competencies in delirium prevention is essential for advancing pediatric critical care quality and promoting holistic patient recovery.