Objective To explore the related factors of recurrence and to construct a risk prediction model in children with primary nephrotic syndrome (PNS). Methods The clinical data of children diagnosed with PNS from January 2013 to January 2020 were retrospectively analyzed. The recurrence of PNS children was followed up, the risk factors affecting recurrence and frequent recurrence were analyzed, the prediction model was established and its efficacy was evaluated. Results A total of 392 children with PNS (192 boys and 200 girls) were included and the median age was 8.0(7.0-10.0) years old. Among the 392 children, 266 (67.9%) had recurrence and 124 (46.6%) had frequent recurrence. Multivariate logistic regression analysis showed that the increase of onset age was an independent protective factor for the recurrence of PNS (P<0.05), and nephritis type and the prolonged time of urinary protein turning negative were independent risk factors for the recurrence of PNS (P<0.05). The regression equation was as follows: Logit (P)= -14.27-1.85× (onset age) +0.65× (clinical type) +1.71× (negative conversion time of urine protein), and the area under the receiver operating characteristic (ROC) curve (AUC) by the model was 0.90 (95%CI: 0.88-0.93). Poor compliance and poor parents' understanding of PNS were independent risk factors for frequent recurrence of PNS (P<0.05), and prolonged first recurrence time was an independent protective factor for frequent recurrence of PNS (P<0.05). The regression equation was as follows: Logit (P)= -0.52+0.54×(compliance)+0.51× (parental cognition to PNS) -0.09 × (first recurrence time), and the AUC predicting frequent recurrence in children with PNS was 0.89 (95%CI: 0.86-0.92). Conclusions The overall recurrence rate of PNS children is high, which is closely related to the age of onset, nephritis type and negative conversion time of urine protein, while children's compliance, parental cognition to PNS and first recurrence time are related to frequent recurrence. Targeted intervention measures should be given to reduce the recurrence rate of children.