Globally, suicide is a leading cause of mortality among teenage children and adolescents. Alcohol and other substances of abuse may influence both the decision to commit suicide and the choice of method. However, only few studies focused on toxicological findings in child suicides. The aim of this study was to map postmortem toxicological findings in child suicides in Sweden. Data on age, sex, suicide method and toxicology in 500 suicides (age 8–17 years) in 2000–2022 were retrieved from the National Board of Forensic Medicine database. Descriptive statistical analyses were performed to examine associations between sex, age, suicide method and toxicology findings. Positive toxicological findings were present in 210 cases (42 %), most frequently among deaths from poisoning and jumping from a high place. Licit drugs were the most common substances (30 %), followed by alcohol (14 %). Antidepressants were the most frequently detected licit drugs and were significantly more common in females (p = 0.002). Among toxicology positive cases, hypnosedatives were detected in 15 % of cases, narcotic analgesics in 9 %, and central stimulants in 6 %. Alcohol was equally common in both sexes, with a mean blood alcohol concentration (BAC) of 1.15 g/L. More than half (57 %) of the alcohol positive cases had BAC levels ≥ 1 g/L. The most common alcohol combinations were with narcotic analgesics and central stimulants. Illicit drugs were rare (n = 14), mainly cannabis. These findings offer insights into child suicides and may inform future suicide prevention strategies targeting children.