Background: Magnetic Resonance Imaging (MRI) is essential in pediatric diagnostics; however, the need for effective sedation due to children’s inability to remain still presents a challenge. Oral Chloral Hydrate (OCH) is commonly used for its efficacy and safety, but there is a lack of detailed exploration of the median induction time, the period from administration to effective sedation. This study aimed to evaluate the efficacy of OCH and identify the determinants of the median induction time for pediatric MRI procedural sedation.Methods: This retrospective study evaluated oral chloral hydrate (50-100 mg/kg) for pediatric MRI sedation using records from the Imam Abdulrahman Bin Faisal Hospital (2018-2022). Pediatric patients (1–8 years) were assessed for sedation efficacy, with exclusion criteria for allergies or incomplete data. Time-to-event analysis (Kaplan–Meier and Cox regression) was used to identify factors influencing sedation induction time. The data included age, weight, dose, and outcomes. The analysis highlighted the key predictors of sedation success and optimized procedural sedation protocols.Results: The study included 183 pediatric patients with a median age of 30 months and a median chloral hydrate dose of 66 mg. Sedation success was 85.79%, with younger age and shorter induction times being significantly associated with success (p<0.001). Kaplan-Meier analysis showed no significant difference in induction times between the neurological and non-neurological groups (p=0.64). Cox regression identified longer MRI duration and multiple doses as significant factors influencing the timing of sedation (p=0.050, p=0.008). Bootstrap analysis confirmed a robust median induction time of 30 minutes.Conclusions: Oral chloral hydrate achieved 85.79% success in pediatric MRI sedation, with younger and lighter patients having better outcomes. The median sleep induction time was 30 minutes, and extending sedation to 60 minutes further improved the success rate.