Objective: To analyze the clinical data of children with acute liver failure to identify risk factors for hemorrhagic complications, thereby providing a basis for clinical diagnosis and treatment decisions in pediatric acute liver failure (PALF). Methods: Clinical data from children diagnosed with acute liver failure and hospitalized at the Children’s Hospital affiliated with Chongqing Medical University from January 2014 to June 2024 were collected. Data included general information, laboratory indicators, and hemorrhagic complications. Patients were categorized into hemorrhagic and non-hemorrhagic complication groups for comparative analysis. Results: A total of 663 cases were analyzed, with 239 cases (36.05%) having hemorrhagic complications and 424 cases (63.95%) without. Only 21 cases (3.17%) had spontaneous bleeding. Multivariate analysis identified infection (OR = 4.05, 95%CI: 2.47~6.64, p < 0.001), hepatorenal syndrome (HRS) (OR = 2.95, 95%CI: 1.82~4.77, p < 0.001), multiple organ dysfunction syndrome (MODS) (OR = 2.47, 95%CI: 1.57~3.88, p < 0.001), low platelet count (≤50 × 10^9/L) (OR = 2.51, 95%CI: 1.58~3.99, p < 0.001), and low fibrinogen (≤1 mg/dL) (OR = 1.73, 95%CI: 1.12~2.69, p = 0.014) as independent risk factors for hemorrhagic complications in children with acute liver failure. Conclusion: Spontaneous bleeding in PALF is relatively rare, with infection, HRS, MODS, thrombocytopenia, and hypofibrinogenemia being high-risk factors for bleeding. Active prevention and control of infections and maintenance of organ function are crucial in preventing bleeding in PALF. Routine coagulation tests like prothrombin time and international normalized ratio are not sufficient to predict bleeding risk in PALF, necessitating a more comprehensive coagulation evaluation system.