The purpose of this study was to retrospectively assess the aetiology of paediatric ocular cranial nerve palsies (CNP) using neuro-ophthalmic data from three hospitals. The study included 1263 patients aged <18 years suspected of having strabismus, from January 1999 to June 2012. 53.4% were female and average follow-up was 14 years. Thirty-three patients had paralytic strabismus with at least six months follow-up. One case was bilateral, and the remainder were unilateral. Mean age at diagnosis was 5.9 ±4.5 years. Over half (54.2%) were aged <six years and 51.5% were male. Twelve patients had congenital CNP and 21 were acquired. Acquired cases were due to trauma (11), undetermined (six), post-viral (three), hydrocephalus (one). There were no cases of tumour or vascular causes. Most frequent palsies were IV (15), VI (13) and III (five). The authors quote an incidence of CNP of 3% in those <18 years of age with the most frequent type being IV and most frequent cause being congenital.