Objective: To determine the prevalence and severity of early childhood caries (ECC) and its relation to feeding practices in Syria. Method and Materials: A total of 400 children aged 3 to 5 years (mean age ± SD, 4.2 ± 0.5) were screened from 20 randomly selected kindergartens in Latakia, Syria. Dental examinations were carried out by a specialist in pediatric dentistry using dmft and dmfs indices and an ECC scoring system. Information regarding feeding practices during early childhood was also collected. Results: Caries was seen in 70% of the children, with a total mean dmft value of 4.25 ± 4.2 per child. The mean values increased from 2.4 ± 3.2 dmft at age 3 to 5.6 ± 4.9 at age 5 (4.1 ± 6.3 and 12.8 ± 12.0 dmfs, respectively). Age and feeding practices showed statistically significant associations with caries (P .001). The mean dmft in the bottlefed children was 5.33 ± 4.6 compared with only 3.27 ± 3.5 in predominantly breastfed children. Fortyeight percent of the children had ECC, and 24% showed a severe degree with carious defects and open caries lesions. A significantly higher prevalence and severity of ECC was observed in children who were bottlefed (z-statistic, -2.1; P = .036) compared with breastfed children. Conclusion: In addition to a high prevalence of caries and ECC in preschool children, bottlefeeding led to even higher caries rates in Syria. Since the caries was largely untreated, preventive and restorative dental programs should be implemented. Keywords: breastfeeding, caries prevalence, early childhood caries, feeding practices, Syria