High flow nasal cannula is an emerging treatment option in paediatric intensive care units for paediatric patients In acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiology. It can avoid invasive method of mechanical ventilation and offers a safe practical approach to oxygen delivery and support. Aim is to describe 9 cases with acute respiratory distress with differing underlying pathophysiology and their response to high flow nasal Cannula oxygen therapy. Patients admitted in PICU with acute respiratory distress with acute encephalitis, congenital heart disease, laryngomalacia etc and treated with HFNC oxygen therapy were chosen to review. 4 infants and 6 children were reviewed. All were commenced on high flow nasal cannula therapy in PICU and all demonstrated an improvement in their work of breathing. 2 patients were referred to higher Centre in view of CHD with improvement on HFNO. There was also a substantial improvement in their haemodynamic status. HFNO Therapy is an viable treatment option for a range of patients presenting to PICU With acute respiratory distress. More invasive method of respiratory support may be avoided by use of HFNC oxygen therapy.