Objective: To determine the clinical spectrum of acute poisoning among children visiting emergency department. Study Design: Cross-sectional study. Setting: Department of Emergency, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: Children of either gender, aged below 12 years and presenting with acute poisoning were analyzed. Demographic, clinical characteristics and final outcomes of children were reported. Results: In a total of 264 children, 139 (52.7%) were boys. The mean age was 4.79±2.02 years. Mode of poisoning was intentional in 31 (11.7%) children. Non-pharmaceutical exposure was reported in 183 (69.3%) children. Route of poisoning was through oral route in 178 (67.4%) children. The mean time to reach hospital was 80.95±77.77 minutes. Respiratory distress, drowsiness, vomiting, and cough were the most frequent presenting complaints, noted in 111 (42.0%), 43 (16.3%), 38 (14.4%), and 32 (12.1%) children, respectively. Type of poisoning substance were found to have significant association with age (p<0.001), time of presentation (p<0.001), mode of poisoning (p=0.011), place of poisoning (p<0.001), route of poisoning (p<0.001), first aid given (p<0.001), ambulance carrying the child to hospital (p<0.001), and final outcome (p<0.001). No mortality was reported. Conclusion: Acute poisoning most commonly affects children up to 5 years of age. Non-pharmaceutical exposure was reported in majority of acute poisoning cases. Respiratory distress, drowsiness, vomiting, and cough were the most frequent presenting complaints.