Introduction: Fever is the most common symptom encountered in paediatric practice and a leading cause of hospital presentation in Sri Lanka. Paracetamol, an over-the-counter medication, is widely used by caregivers as the first-line antipyretic. However, inappropriate dosing remains a concern, with underdosing leading to inadequate symptom control and overdosing posing a risk of hepatotoxicity . Objectives: To evaluate pre-admission paracetamol use, dosing accuracy and the influence of healthcare consultation, among febrile children admitted to a tertiary paediatric ward in Sri Lanka. Methods: A cross-sectional clinical audit using bead head ticket was conducted over five months at the paediatric ward (26B) of Ratnapura Teaching Hospital. Children aged 6 months to