Statement of the Problem: Dental caries in infants and young children is prevalent worldwide; its magnitude and associated factors vary between communities because of cultural and social economic differences. No such information was available for pre-school children in Mbeya city.Purpose: To determine dental caries status and associated factors in 2 to 4-year-old children in Mbeya city.Materials and Method: A cross sectional study was conducted among 525 children aged 2-4 years and their parents/caregivers. Caries was assessed using caries assessment spectrum and treatment index, oral hygiene by visual inspection for visible plaque on index teeth, and dietary and oral hygiene habits by a questionnaire. Kappa statistics was used to test reliability of study instruments, c2-test and logistic regression was employed for studying associations.Results: Caries free children for dmft1, dmft2 and dmft3 were 79.8%, 83.8% and 94.7% and caries experience was 0.49 (1.23), 0.4 (1.14) and 0.10 (0.53) respectively. Older age [(OR =2.722 (1.617-4.582) p=< 0.001)]; and frequent consumption of factory made sugary foods/snacks at age 1-2 years [(OR=3.061 (1.188-7.887) p=0.021] were associated with caries. Prolonged breastfeeding for more than 1 year and breastfeeding at night had no association with dental caries.Conclusion: The prevalence of dental caries was very low. Older age and frequent consumption of factory made sugary foods at age 1-2 years were associated with higher odds of developing dental caries. Prolonged breasfeeding and breastfeeding at night had no association with dental caries. Prevention of dental caries should be instituted as soon as primary teeth start erupting, especially through discouraging consumption of factory made sugary foods/snacks. Keywords ● Dental caries  ● Risk factors  ● Children  ● Preschool  ● Tanzania