Objective To evaluate the characteristics and related influencing factors of blood-borne occupational exposure among pediatric health care workers (HCWs), so as to provide effective references for their occupational safety protection. Methods 643 cases of blood-borne occupational exposure among pediatric HCWs in a tertiary first-class children's hospital from 2013 to 2022 were analyzed retrospectively, including basic information of occupational exposure, exposure sites, exposure occasions, exposure causes, post-exposure emergency treatments and follow-up. Results Nurses were the main occupational exposure group of pediatric HCWs (86.00%), with a relatively high proportion of occupational exposure among those aged ≤25 years (64.39%) and those with less than 5 years of service experience (77.76%). The department with the highest incidence of occupational exposure was the emergency department (27.53%), and the peak of occupational exposure throughout the year was from June to August. Through the implementation of the plan-do-check-act (PDCA) cycle projects to improve the implementation of protective measures for blood-borne occupational exposure, the overall incidence of blood-borne occupational exposure in this hospital from 2013 to 2022 showed a decreasing trend year by year (χ²=195.79, P < 0.001). The major type of exposure was sharp instrument injuries (89.89%). Hands were the most exposed sites (91.44%). The top three exposure occasions/operations were sorting/cleaning items/instruments (38.41%), blood collection (16.95%) and needle extraction (14.15%). The main sources of occupational exposure in children's hospital were non-blood-borne pathogens (71.38%), with a certain proportion of accidental injuries by others during operations (18.66%). Conclusion The influencing factors of occupational exposure for pediatric HCWs are complex. Causes should be analyzed based on their exposure characteristics. Attention should be paid to key populations, key sites and key seasons, and targeted prevention and control measures should be taken to prevent the occurrence of blood-borne occupational exposure.