Combined effects of global warming and rapid urbanization replace green spaces with urban facilities. Children in urban areas are at a higher risk of heat-related adverse health effects. Our study aimed to examine the protective effect of urban green space on heat-related respiratory hospitalization among children under 5 years of age in Hanoi, the capital city of Vietnam. We estimated district-specific meteorological conditions from 2010 to 2014 by using a dynamic downscaling approach with a fine-resolution numerical climate model. The green space in each district was calculated using satellite data. The attributable fraction of heat-related respiratory hospitalization was estimated using a two-stage model, including a distributed lag non-linear model (DLNM) coupled with multivariate meta-analysis. The association between heat-related respiratory hospitalization and green spaces at the district level was explored using a linear regression model. The central districts were more crowded and hotter, with less green spaces than the outer districts. At temperatures > 34 °C (extreme heat threshold), the hospitalizations in the central districts increased significantly; however, in the outer districts, the hospitalization rate was insignificant. On average, extreme heat attributed 0.33% to citywide hospitalization, 0.35% in the center, and 0.32% in the outer region. Every 1% increase in the green space fraction will reduce heat-related respiratory hospitalization risk by 3.8%. Heat significantly increased the risk of respiratory hospitalization among children under 5 years in Hanoi, Vietnam. These findings are valuable for authorities to consider strategies to protect children’s health against the effects of heat, including increasing green space.