Context: Oral premedication is commonly used in pediatric anesthesia to provide preoperative anxiolytics and to ensure smooth induction. Midazolam is currently the most commonly used premedication, but newer drugs such as dexmedetomidine have emerged as alternatives for premedication in the pediatric population. Aims: The aim of the study is to compare the clinical effects of oral dexmedetomidine and oral midazolam on preoperative sedation and postoperative recovery profile in children. Materials and Methods: We performed a prospective, randomized, double-blinded controlled study in 106 children, 2–10 years of age undergoing elective surgeries under general anesthesia. Patients were randomly assigned to receive either oral dexmedetomidine 4 mcg/kg (Group D, n = 53) or oral midazolam 0.5 mg/kg (Group D, n = 53) 40 minutes prior to mask induction. Preoperative sedation and anxiolytics, the response of the child during separation from the parent, quality of mask acceptance and recovery profile were compared for the two groups. Statistical Analysis: Results were analyzed using an unpaired Student’s t-test and Chi-squared test. p < 0.05 was considered statistically significant. Results: The level of preoperative sedation at the end of 40 minutes was significantly higher in the dexmedetomidine group (3.74 ± 0.07) than the midazolam group (3.17 ± 0.10). Response to parental separation and quality of mask acceptance was significantly better in group dexmedetomidine compared to group midazolam (p > 0.05). Intraoperative Heart rate and Mean Arterial Pressure (MAP) was lower in the dexmedetomidine group compared to midazolam group. The incidence of postoperative agitation was significantly less in the dexmedetomidine group (p < 0.05). Conclusion: In this study, we concluded that the premedication with oral dexmedetomidine produced better preoperative sedation and recovery from anesthesia in pediatric population compared to premedication with oral midazolam.