Background <p>Pediatric nurses play pillar roles in providing continuous, holistic care for critically ill children. Hence, family satisfaction and nursing care competencies have surfaced as critical channels of quality of care in pediatric intensive care units.</p> Aim <p>This study aimed to investigate the relationship between children’s family satisfaction and nursing care competencies in Pediatric Intensive Care Units.</p> Methods <p>A cross-sectional correlational research design was conducted in five pediatric intensive care units at children’s hospitals related to different health sectors in Alexandria. A convenient sample of 150 pediatric critical care nurses who provided direct care for critically ill children in Pediatric Intensive Care Units (PICUs) and 218 families of critically ill children. The children’s socio-demographic and clinical data record, the pediatric family satisfaction with care in the intensive care unit questionnaire, and the nurse professional competence scale-short version were used to collect data.</p> Results <p>The findings of the study showed that the mean score of overall pFS-ICU was 80.0 ± 5.75 and the mean score of overall NPC-SV was 101.75 ± 19.66. Additionally, a significant strong positive correlation was reported between the overall NPC-SV and overall families’ satisfaction (<i>r</i> = 0.656, <i>p</i> &lt; 0.001).</p> Conclusion <p>Family satisfaction in the PICU is strongly influenced by nurses’ medical and technical competence and their ability to deliver well-organized, accurately documented care. While interpersonal, educational, and leadership competencies remain essential components of holistic nursing practice.</p> Clinical trial number <p>Not applicable.</p>