Introduction: Malnutrition in children with congenital heart disease (CHD) is a significant global health concern, driven by increased metabolic demands, feeding difficulties, recurrent infections, and chronic hypoxaemia. It is associated with impaired growth, increased morbidity , and higher surgical risk. In Sri Lanka, although approximately 3,255 children are born with CHD annually , data on their nutritional status remain limited. Objective: To assess the nutritional status and associated factors among children with CHD attending a tertiary paediatric cardiology clinic in Kandy , Sri Lanka. Method: A descriptive analytical cross-sectional study was conducted among 218 children aged 6–59 months with CHD awaiting surgery or managed conservatively . Data were obtained through questionnaires, echocardiographic records, anthropometry , and biochemical and haematological assessments. Malnutrition was defined using WHO Z -scores (≤–2 SD). Analysis was performed using SPSS 22.0 with p40%) was present in 69.3% and strongly associated with malnutrition (p