OBJECTIVE: Dengue infection still poses a serious health problem, especially in tropical climate countries. Liver dysfunction is a common issue found in children with dengue infection, in which manifested by liver enlargement and elevated transaminase levels. Aspartate transaminase (AST) and Alanine transaminase (ALT) values have been found to be higher for severer forms of dengue than for uncomplicated dengue fever. However, AST/ALT ratio is rarely used in diagnosing dengue severity. This study aimed to look for association between AST/ALT ratio and dengue severity in children.                                                                                                                                  METHOD: This study is an analytical cross-sectional study using medical record data of patients in Child Health Department Prof. Dr. R. D. Kandou Hospital Manado, taken between January – February 2019. 40 patients aged 0-18 years whom met the inclusion criteria were included in this study. Diagnosis of Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) were made according to WHO 2011 criteria. AST and ALT results were collected and AST/ALT ratio were calculated. Data analysis were done with logistic regression test using SPSS version 22 software.                                                                                                                                    RESULT: Total of 40 subjects were enrolled, consisted of 19 boys and 21 girls. Data were grouped into DHF and DSS, with 17 of them diagnosed as DHF, and 23 diagnosed as DSS. Data analysis showed significant association between AST/ALT ratio and dengue severity in children (p value = 0.043).                                                                                                                               CONCLUSION: Higher AST/ALT ratio is associated with dengue severity in children.