The aim of the study was to discover cases of childhood leptospirosis in four municipalities in the region of Urabá (Colombia) and the factors related to the severity of clinical manifestations. A retrospective cross-sectional study assessed 74 children aged younger than 17 years with febrile syndrome due to leptospirosis between 2010 and 2012. The majority of cases were in children from urban areas (57/74; 77%), between 10 and 14 years of age (33/74; 44.5%). The microscopic agglutination test (MAT) revealed that the most frequent serogroups were Grippotyphosa and Bratislava, which are associated with wildlife and livestock reservoirs, respectively. There was a association between the presence of household pets and the severity of the disease (odds ratio [OR] 2.73; 95% confidence interval [CI] = 0.98-7.60; p=0.05). The risk of severe childhood leptospirosis is linked to having household pets.