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Introduction: Developing countries like India still depend on Replacement Donors (RD) for their blood requirements. Healthcare providers in India often face Replacement Blood Donation (RBD) denials in children especially in rural areas. Aim: To find reasons for RBD denials in children. Materials and Methods: A cross-sectional study was done over six months at a tertiary care centre located in rural part of Northern India. Children requiring Blood Transfusion (BT) whose parents refused RBD were included in the study. Children were divided into three groups based on their age and data on various parameters were collected. Observation parameters included sex, birth order, number of siblings, disease for which admitted, duration between admission and need for transfusion, indication for transfusion, decision maker in the family, resistance to decision of denial by any other member of family, parental education, socio-economic status and reasons for denial. Data were analysed using SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc, Chicago, Ill, USA). The p-values were computed for categorical variables using Chi-square (χ2) test. A p-value of less than 0.05 was considered statistically significant. Results: Out of 356 children requiring BT, parents and relatives of 130 children (36.51%) refused RBD. Of these 130 children, 84 were females and 46 were males with male-female ratio of 1:1.8. Females were more likely to be denied RBD (p-value=0.001). Of these 130 children, only 77 could be included in the study because of various reasons. Age of the study group ranged between 2 days to 15 years. Denials were significantly higher (p-value=0.0032) in children with 3rd or higher birth order. Little benefit in terms of life expectancy was the commonest reason for denials in neonates and was found statistically significant (p-value=0.00368). Fear of donation was the most common reason for denial in all the groups combined (38.9%). Considering themselves ineligible and religious beliefs were the other reasons for denials. Conclusion: RBD denial in children is common in India. Misconceptions, Illiteracy, poverty, sex discrimination and false beliefs are major contributory factors for denial.