Objective Organophosphate poisoning (OPP) is a significant cause of mortality in resource-poor countries, especially in economies such as that of South Africa where agricultural activity remains an important contributor to the economy. Long-term neurobehavioural sequelae of OPP have been reported in adults, but little is known about the neurodevelopmental outcomes of children who survive acute organophosphate pesticide poisoning, including that from domestic exposure. This study aimed to determine the performance of South African children surviving acute episodes of OPP on a standardized neurobehavioural battery compared to a control group of children previously admitted to hospital with paraffin poisoning. Methods Children were included who were 3–12 years with a previous admission for OPP to the Red Cross Children's Hospital, Cape Town. The control group comprised children admitted for paraffin poisoning and were matched to the index group for age, gender, home language, admission date and illness severity. All children were assessed for neurodevelopmental function. Caregivers were administered a questionnaire-based behavior rating scale, Achenbach System of Empirically Based Assessment. The neurodevelopmental performance and behaviour of OPP children was compared to that of the controls. Results A total of 91 children were tested, 46 OPP and 45 control children. No between group differences were found on any measures. Conclusion Although there were no significant differences between the children with OPP and those with acute paraffin exposure on preliminary analysis, possible explanations for this include sample size too small to detect subtle differences, exclusion from the study of children who had severe neurodisability or who had died due to OPP. Between group effects of these children may also have been masked by high prevalence risk factors in South Africa for poor development such as low socio-economic status, HIV exposure, maternal alcohol and smoking during pregnancy and poor maternal mental health.