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Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease related optic neuritis (MOGAD-ON) is a rapid onset, severe neuroinflammatory condition which is typically steroid responsive. This study sought to characterise the natural history of paediatric MOGAD-ON.This single centre study retrospectively studied all paediatric patients (<18 years old) who presented since 2014 who had a positive MOG-IgG titre on a live cell-based assay. Children were identified as having optic neuritis if they had evidence of disc swelling (on slit-lamp examination or OCT) or MRI features consistent with optic neuritis.Over the study period 41 patients (mean age 10) were found to have a positive MOG-IgG test with a mean follow-up of 45.2 months (range 1–53 months). 35 patients had sufficient retrospective data for study inclusion. 20 children had optic neuritis at presentation (10/20 bilateral). Mean age at presentation was higher in those children who presented with optic neuritis (8.45yrs vs 5.86 yrs) (p <0.05). 21 children had a monophasic disease course, and 14 children had relapses. In 11/14 children relapse phenotype was the same as the phenotype at presentation. 4/20 of the children presenting with optic neuritis required escalation to plasma exchange or IVIG. 33/35 patients had 6/9 or better vision in both eyes at time of last follow-up.This study represents the joint-second largest natural history study of paediatric MOGAD-ON. Optic neuritis as a presenting feature of MOGAD is associated with a greater age at presentation. Paediatric patients presenting with MOGAD-ON have excellent visual outcomes, often with steroid treatment alone.