Objective To analyze the information and composition of the initial hospitalization expenses of children with acute leukemia, and to discuss the influencing factors and changing trend of the initial hospitalization expenses of children with acute leukemia. Methods Medical record data were collected of children aged 0 to 13 years old admitted to the paediatric internal medicine department of a tertiary hospital and diagnosed with acute leukemia in recent five years. The primary hospitalization information of children with acute leukemia was statistically described and the influencing factors of primary hospitalization cost were analyzed by single factor analysis and multiple linear regression analysis. Results Totally 124 cases were included, the average hospitalization cost was 2 3284.39 yuan, and the average daily hospitalization cost was 1 071.63 yuan. Univariate statistical analysis results showed that the age, admission year and length of stay of pediatric leukemia children were statistically significant, while the multivariate statistical analysis found that the admission to ICU was statistically significant.Conclusion In the total cost of the first hospitalization of children with leukemia, western medicine expenses and other expenses account for a large proportion. The length of hospital stay was the main factor influencing the total cost of the first hospitalization for acute leukemia in children. Factors such as whether or not to be admitted to the ICU are the main influencing factors of the average daily hospitalization cost. Properly reducing the western medicine cost and reducing ineffective or inefficient hospitalization days can effectively reduce the family economic burden of children with acute leukemia.