Objective　To explore the relationship between serum albumin (ALB) combined with red blood cell distribution width (RDW) in progression and prognosis of children with heart failure. Method　A total of 144 children with heart failure were divided into light, medium, and heavy group according to the modified ROSS score; another aspect, they also were divided into survival group and death group. ALB, RDW, and modified ROSS score were measured to assess the relationship between the factors and the death by logistic regression analysis. Results　There are 73 boys and 71 girls. The cases of mild, moderate, and severe group were 78, 39, and 27, respectively. Age and gender difference in three groups were not statistically significant (P>0.05). The ratio of high RDW was 54.86% (79/144), the ratio of low serum ALB was 33.33% (48/144). Chi-square analysis indicated that a severer status of the disease correlated with a lower ALB level (P <0.05) and a higher RDW. The analysis of rank correlation indicating the degree of heart failure was negatively correlated with the related trends of ALB and RDW (P<0.05). Logistic regression analysis indicating a higher risk of death of the disease correlated with a lower ALB level (P<0.05， OR=0.839) and a higher modified ROSS score (P<0.05，OR =1.324). Conclusions　The ALB, RDW, and the modified ROSS score are closely related to the severity in heart failure children. The ALB and the modified ROSS score have important clinical prognostic significance in evaluating the prognosis.