Background: The Child Health and Development Record (CHDR) book is a parent-held home-based record issued by the Ministry of Health Sri Lanka to ensure continuity of childcare including growth monitoring, immunisation tracking, nutrition guidance, and developmental surveillance. Effective utilisation is essential for early detection of growth and developmental abnormalities ¹,². Objectives: To evaluate availability , caregiver utilisation, and knowledge regarding the CHDR among paediatric admissions. Methods: A descriptive cross-sectional audit was conducted among 200 caregivers of children admitted to Ward 21, District General Hospital Nuwara Eliya from 1st Of January to 31st of January 2026 . Data were collected via interviewer-administered questionnaires and CHDR review checklists. Results: CHDR availability , clinic carriage, and health worker utilisation were 100% (n=200). Developmental milestone awareness was 76% (n=152), while 72% (n=144) had reviewed the milestones section. Only 30% (n=60) could correctly mention a milestone. Feeding and weaning awareness was 96% (n=192), with 78% (n=156) having read . CHDR availability , clinic carriage, and health-worker utilisation were 100%. Caregiver awareness of developmental milestones was 76%, with 72% having reviewed the section; however, only 30% could correctly mention a milestone. Feeding and weaning awareness was high at 96%, and 78% had read the feeding guidance. Conclusion: Despite optimal institutional utilisation, caregiver developmental literacy remains suboptimal. Strengthened parental education and structured counselling interventions are recommended to improve early childhood surveillance outcome .