Introduction: Patient safety is central to high-quality paediatric care, yet evidence from lowand middle-income settings suggests that clinician knowledge may not translate into safer clinical practice. Objective: To assess knowledge, attitudes, practices, and perceived barriers regarding patient safety and error reporting among paediatricians in Sri Lanka. Methods: A cross-sectional online survey was administered to practising paediatricians acros diverse healthcare settings in Sri Lanka. A validated questionnaire assessed demographics, knowledge, attitudes, practices, contributing factors, case-based reporting behaviour, and open-ended suggestions. Descriptive and inferential analyses were performed using R statistical software. Associations between demographic variables and knowledge scores were analysed using non-parametric tests. Spearman correlation assessed relationships among KAP domains. Results: Total of 150 paediatricians responded; 79.2% had over 10 years of experience. Knowledge levels were high, with 11/13 items achieving >80% accuracy . However, 87 .2% had not received patient safety training within the past year. Good safety attitudes were observed in 49.7%, while 37 .4% were neutral. Although 72.5% reported witnessing an error or near-miss in the preceding year, 41.1% indicated that Morbidity and Mortality reviews were never conducted. High workload (25.1%) and system/equipment issues (18.5%) were the leading perceived contributors to errors. Reporting intent increased with perceived severity of harm. No significant correlations were observed between knowledge, attitude, and practice domains, demonstrating a theory–practice gap. Conclusions: Despite solid conceptual knowledge, paediatricians face structural and cultural barriers that limit effective error reporting and institutional learning. Strengthening formal training, non-punitive reporting systems, and workload management may enhance patient safety in paediatric services.