BACKGROUND The aim is to study the need for surgical intervention among children with snake envenomation. MATERIALS AND METHODS This was a prospective observational study from a paediatric intensive care unit of a tertiary care institute. Clinical presentation, type of envenomation, need for ASV, duration of hospital stay, surgical intervention and final outcome were studied. Data was analysed using Epi Info software. This study was undertaken after ethical approval and informed consent of caregivers. RESULTS In this study of 35 children, male female ratio was 3.4:1. 71% were neurotoxic and 69% had local envenomation. Compartment syndrome was encountered in 13 children (37.14%). Amputation of the middle finger was undertaken in one child. Initial fasciotomy with subsequent wound debridement was done in 8 children. Split skin grafting was done in 5 children. 36% of children with neurotoxic envenomation and 54% with local envenomation and 16% with haemotoxic envenomation required surgical intervention. Comparison of factors like age, gender, bite to ASV receipt time, number of ASV vials used, initial blood glucose, white blood counts, native treatment did not show any statistically significant difference as risk factors for surgical intervention. Children needing surgical intervention needed a longer hospital stay compared to those who did not need surgical intervention. Except for one child with features of Russell's viper bite others were due to cobra bite in this study group. Overall mortality was 5.7%. CONCLUSION 36% of children with snake envenomation from rural areas needed surgical intervention.