Anti-retroviral Therapy (ART) is a major intervention for children infected and exposed to HIV infection and it influences their morbidity and mortality.Objective: To investigate factors influencing ARV uptake in HIV positive and exposed children aged below 14 years in Meru North District. A descriptive cross-sectional study. Setting: The Nyambene District Hospital, Miathene Sub - District Hospital and Maua Methodist Hospital paediatrics comprehensive care clinics (PCCC) in Meru North District. Subjects: Parents or guardians with children less than 14 years of age exposed or infected with HIV who visited the selected health facilities. About 222 caregivers were interviewed with mean age of 38.4 + 10.3 years ranging from 21 to 70 years. About 120 (54.0%) were aged between 30 to 39 years, Most of the caregivers 106 (47.7%) had acquired education up to primary level. Marital status of the caregivers revealed that 104 (46.8%) were married while 16 (6.3%) were cohabiting. Relationship between children ARV uptake and marital status of caregiver was significant (OR= 2.1, 95% C.I= 1.0 – 4.6, P=0.050). Significant association between source of medical advice and children ARV uptake (P<0.05) was evident. Conclusion: Achieving widespread public health benefits of ARV roll-out requires community - level interventions in marriages and information distribution to ensure local acceptability of antiretroviral drugs. Better management and improvement of health status of HIV exposed and infected children will be enhanced by improved ARV uptake. The study recommends integration and decentralization of ARV services through social supports, encouraging disclosure of HIV statuses for positive living and enhanced ARV uptake and enhanced awareness creation on ARVs and HIV information to caregivers at all levels.