Children represent a significant portion of the population in developing countries and are highly vulnerable to diseases. Self-medication, the practice of using medications without professional guidance, has been widely reported. While it can alleviate minor illnesses, self-medication, particularly in children, poses significant risks, including misdiagnosis, drug interactions, and antibiotic resistance. Little research exists regarding pediatric self-medication practices in Libya, raising concerns about the safety and appropriateness of these practices. This study aims to assess the prevalence of pediatric self-medication among parents and caregivers in Derna, Libya. Additionally, it aimed to investigate the factors influencing parental decisions and attitudes toward self-medication for children. A cross-sectional survey was conducted in Derna City using a self-administered questionnaire distributed through face-to-face interviews and an online link in 2025. The study revealed 54.4% of the participants practiced pediatric self-medication. Fever (66.4%) and cough (65.7%) were the most frequently treated symptoms. Pharmacies were the main source of medications (92.8%). Antibiotics were used by 20.4% of respondents, and 75.1% reported self-medication for their children within the past three months. When treatment failed, 83.4% sought medical advice. The prevalence of pediatric self-medication is alarmingly high, with several parents relying on pharmacies and previous prescriptions. This practice poses significant health risks, particularly in relation to the misuse of antibiotics.