Introduction: Snake envenoming remains a major public health problem in Sri Lanka, disproportionately affecting rural children. Public Health Midwives (PHMs) play a key role in community-level prevention and early management, yet their knowledge regarding paediatric snakebites has not been nationally evaluated. Objectives: To assess knowledge and practices of PHMs regarding prevention, snake identification and pre-hospital management of paediatric snakebites, and to identify factors associated with adequate knowledge. Methods: A nationwide cross-sectional survey was conducted among 1,706 PHMs across all 25 districts using stratified random sampling. A validated, self-administered questionnaire assessed knowledge on first aid, snake identification, envenomation, treatment and prevention. Knowledge scores were categorised as adequate or inadequate. Associations were analysed using Chi-square tests. Results: Although most PHMS recognised the importance of reassurance (95.9%) and immediate hospital transfer (95.8%), many endorsed harmful practices such as sucking venom (71.6%), applying herbs (73.2%) and cutting the bite site (64.4%). Only 48.7% identified limb immobilisation as appropriate first aid. Snake identification accuracy was high for cobra (94%) but low for kraits and vipers (