Background <p>Paracetamol is one of the most widely used analgesic and antipyretic medications in children. Although it is considered safe at therapeutic doses, its widespread availability and low cost increase the risk of overdose and poisoning. Delayed recognition and treatment of paracetamol intoxication may result in serious complications, whereas early diagnosis and appropriate management are associated with favorable outcomes. This study aimed to evaluate the demographic characteristics, clinical and laboratory findings, management strategies, and outcomes of pediatric patients presenting to the emergency department with paracetamol intoxication.</p> Methods <p>This retrospective descriptive cohort study included pediatric patients admitted to the Pediatric Emergency Department of Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital between January 2017 and January 2019 due to paracetamol overdose. Data regarding age, sex, intent of ingestion, ingested dose, time to hospital presentation, clinical presentation, laboratory findings, and treatment modalities were analyzed. Toxicity risk and the need for antidotal therapy were assessed using the Rumack–Matthew nomogram. Descriptive and comparative statistical analyses were performed.</p> Results <p>A total of 197 patients were included; 63.5% were female and 36.5% were male. Accidental ingestion accounted for 49.2% of cases, whereas 50.8% were intentional. Accidental ingestion was more common in boys, while intentional ingestion predominated in girls (<i>p</i> &lt; 0.001). The mean time to hospital admission was 3.1 ± 3.9 hours. Paracetamol was ingested alone in 42.1% of patients and in combination with other drugs in 57.9%. At presentation, 68.5% of patients were asymptomatic, and nausea and vomiting were the most common symptoms (16.2%). Gastrointestinal decontamination was performed in 81.6% of patients, and 14.7% received <i>N</i>-acetylcysteine therapy. Only 2 patients (1.0%) had serum paracetamol levels above the treatment line on the Rumack–Matthew nomogram. Serum paracetamol levels were measured in 137 patients (69.5%); of these, 2 (1.5%) had levels above the Rumack–Matthew treatment threshold. No cases of clinically significant hepatotoxicity, acute liver failure, liver transplantation, or mortality were observed.</p> Conclusions <p>Paracetamol poisoning constitutes an important proportion of pediatric emergency admissions. Early presentation and appropriate clinical management are associated with excellent clinical outcomes. These findings highlight the importance of early risk assessment and timely treatment in pediatric paracetamol intoxication.</p> Trial registration <p>Not applicable.</p>