Introduction: Epilepsy is a common chronic neurological disorder in childhood and is frequently accompanied by emotional and behavioural difficulties. While seizure control is often the primary therapeutic focus, the psychological burden experienced by children with epilepsy in remains insufficiently characterised. Understanding the extent and determinants of psychological distress is essential for comprehensive epilepsy care. Objectives: To estimate the frequency of psychological distress among children with epilepsy and to examine its association with seizure-related and sociodemographic factors. Methods: A cross-sectional study was conducted among 155 children with epilepsy attending a tertiary paediatric neurology clinic in Sri Lanka. Depression, anxiety and stress were assessed using the Depression Anxiety Stress Scales (DASS-21). Median scores and severity categories were described. Associations with seizure control, recent seizure occurrence and household income were examined using Mann–Whitney U tests, Kruskal–Wallis tests and multivariable linear regression. Results: Moderate or higher symptoms were observed in 36.1%, 29.7%, 31.6% for depression, anxiety and stress respectively . Psychological distress scores did not differ significantly between seizure-free and not seizure-free groups, nor between those with and without seizures in the preceding three months (all p > 0.05). No significant differences were observed across household income categories. In multivariable analyses, seizure-related and sociodemographic factors were not independently associated with DASS-21 subscale scores. Conclusions: A substantial proportion of children with epilepsy experience clinically significant psychological distress, independent of short-term seizure activity or socioeconomic status. Routine psychological screening should be integrated into paediatric epilepsy care in Sri Lankan settings.