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Objectives To assess the clinical profile and identify risk factors associated with global developmental delay (GDD) among children aged 1 to 5 years attending the Neurology and Developmental and behavioral pediatrics clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.Methods A hospital-based descriptive cross-sectional study was conducted from November 2024 to January 2025. Data were collected from 227 children using a pretested structured questionnaire and Ages and Stages Questionnaire (ASQ). Bivariate and multivariable logistic regression analyses were performed to identify factors associated with GDD. Descriptive statistics were presented using tables and graphs.Results Of 227 participants (79.6% response rate), 58.1% were aged 25–48 months and 84.6% resided in urban areas; 62% of mothers had primary education. Preterm birth occurred in 29.1%, 47% required resuscitation, and 58.1% were admitted to NICU. The prevalence of GDD was 76%, with communication delays in 73.6% and problem-solving delays in 79.4%. Significantly associated factors for GDD included age 25–48 months (AOR=2.6), female sex (AOR=1.9), and rural residence (AOR=2.8). Cesarean section delivery was protective, reducing GDD risk by 66% (AOR=0.44).Conclusions A high proportion of children attending the Neurology and Developmental Clinic exhibited global developmental delays, particularly in communication and problem-solving domains. Maternal health factors, neonatal complications, and socio-environmental conditions were significantly associated with developmental delays. These findings underscore the importance of routine developmental screening and tailored interventions within clinical settings to support at-risk children and improve developmental outcomes.