Purpose: To assess the survival and risk factors associated with the failure of atraumatic restorative treatment (ART) restorations placed in children with early child-hood caries (ECC).<br/> Methods: The sample consisted of 286 restorations from the records of 137 children treated in a university dental clinic. The date of restoration placement, any reintervention (failure), and the patient's last checkup were recorded. Restoration longevity up to one year of follow-up was assessed via the Kaplan-Meier survival test. Multi-variate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P <0.05).<br/> Results: The mean age of the children was 2.3±0.6 years, presenting a decayed, missing, and filled teeth (dmft) mean of 6.3±3.2. Mean survival time was 11.1 months (95 percent confidence interval = 10.8 to 11.4), with 85 percent of the restorations surviving after one year. Caries experience was associated with risk of restoration failure in crude analysis. ART restorations done in children with high caries experience had 2.71 times more risk of failure than those placed in children with moderate caries experience (P=0.03). However, the association lost its significance in the adjusted model (P=0.07).<br/> Conclusion: ART is a patient-friendly approach to manage ECC that promotes satisfactory restoration survival after one year.