Background: Pediatric inguinal hernia is one of the frequent causes of childhood morbidity. Therefore, the aim of the present study was to determine the incidence of metachronous contralateral inguinal hernia in pediatric patients aged ≤ 12 months, in Northern Saudi Arabia. Methodology: In the present study, records of a series of 90 pediatric patients (aged ≤ 12 months) were presented with inguinal hernia and have subsequently undergone inguinal hernia repair. Results: About 2/30 (6.6%) with left side hernia were found with subsequent right side metachronous contralateral inguinal hernia (MCIH) occurrence. One out of the two 1/2 (50%) was found at the age of 2 months, the other one 1/2 (50%) was at the age of 6 months. The 3/54 (5.5%) with right inguinal hernia developed a contralateral hernia, of whom 2/3 (66.6%) were found at the age of 12 months, and one 1/3 (33.3%) was at the age of 2 months. Conclusion: The findings of the present study suggest that there is a relatively higher incidence of contralateral inguinal hernia if the initial presentation was on the left side, which necessitates a close follow up for those patients; however, there is not enough evidence to support routine exploration of the contralateral groin surgically.