Background Parents of children in pediatric intensive care units have varied communication experiences with health care professionals. Little is known about factors associated with parents' perceptions of miscommunication.<br /> Objective To examine children's clinical and parents' demo-graphic and psychosocial factors associated with perceptions of miscommunication in the pediatric intensive care unit. Methods This study was a cross-sectional survey of parents of children admitted to the pediatric intensive care unit between January 1, 2018, and February 29, 2020, with a stay of greater than 24 hours.<br /> Results Most of the 200 parent respondents were female (83.4%), White (71.4%), and non-Hispanic (87.9%); median age was 39 years (mean [SD], 40.2 [8.75] years); 17.6% were Black or African American. Among 210 children, mean (SD) age was 6.1 (6.02) years, mean (SD) stay was 4.5 (6.2) days, 38.6% were admitted because of respira-tory illness, and the admission was the first for 51.0%. Of the parents, 16.5% reported miscommunication in the pediatric intensive care unit. In multivariable linear regres-sions, parents' stress (beta = 0.286), parents' views of clinician communication (beta = -0.400), parents' trust in physicians (beta = -0.147), and length of stay (beta = 0.122) accounted for 45% of the explained variance in parent-perceived mis-communication (R-2 = 0.448, F = 41.19, P < .001).<br /> Conclusions Parental stress and trust in physician scores were associated with perceived miscommunication. Fur-ther research is needed to understand the causes and consequences of miscommunication in order to support hospitalized children and their parents. (American Jour-nal of Critical Care. 2024;33:402-409.