AIM: This study aimed to examine the relationship between nursing students' math anxiety and their self-efficacy in pediatric medication administration. BACKGROUND: Medication errors in pediatric patients are often linked to the precision required in dose calculations, posing significant risks to patient safety. Math anxiety, characterized by fear and worry, can impair students' performance in mathematical tasks, potentially reducing self-efficacy in medication administration. DESIGN: A descriptive, cross-sectional, correlational design was employed, adhering to STROBE guidelines. METHODS: The study was conducted between May and July 2022 with 175 third- and fourth-year nursing students at a state university financed by public funds, in Turkey. Data were collected through a sociodemographic information form, a self-efficacy scale for pediatric medication administration, and a two-dimensional math anxiety scale. Statistical analyses included descriptive statistics, t-tests, ANOVA, and Pearson correlation. RESULTS: Third-year students had higher drug preparation scores than fourth-year students. Students who willingly chose nursing had higher self-efficacy. Those confident in calculation skills had higher self-efficacy and lower math anxiety. Higher math anxiety negatively correlated with drug preparation scores, while calculator use was linked to increased anxiety and lower scores. No significant correlation was found between math anxiety and overall self-efficacy. CONCLUSION: Reducing math anxiety and enhancing mathematical skills may improve nursing students' self-efficacy in pediatric drug administration. Nursing education should incorporate strategies to strengthen mathematical competencies.