Background: Acute poisoning remains a leading cause of emergency hospital admissions among children. Its patterns and trends are shaped by the availability of toxic agents and by prevailing social, cultural, and economic determinants. Methods: In this cross-sectional study , all paediatric acute poisoning admissions at Base Hospital Valaichenai from July 2022 to June 2025 were reviewed. Data were collected using a standardized checklist, which was refined following a five-case pilot study , to obtain information on demographics, poisoning agents, and clinical outcomes. Administrative approval was obtained to access patient records. Data were analyzed using SPSS version 22. Results: A total of 129 children were admitted with acute poisoning during the 36-month study period. The majority were boys (63.5%) and children aged 1–5 years (72.8%). Most poisoning events were accidental, with nine cases (6.9%) of deliberate poisoning observed among adolescents. The most common poisoning agents were pharmaceuticals (34.8%), household chemicals (34.1%), and plants (18.6%); no pesticide-related poisoning was reported. The most frequently identified individual poisons included kerosene oil (11.6%), paracetamol (8.5%), and lucky money plant exposure (7 .7%). Three children (3.3%) required referral to higher-level care, while the majority recovered with observation alone. No mortality was reported. Conclusion: The study trends differed from previous Sri Lankan reports, with household and pharmaceutical agents more common than plant poisons. Outcomes were generally good; however, caregiver education and stricter control of toxic substances remain essential for prevention.