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Objectives To evaluate the incidence, pattern and risk factors of early cardiotoxicity and to assess the impact of undernutrition in children with Wilms tumour (WT) and hepatoblastoma receiving anthracycline-based therapy.Methods In this retrospective cohort study, 137 children treated between 2017 and 2022 were analysed. Cardiac function was monitored by serial echocardiography, and nutritional status was assessed using WHO and Pediatric Hematology‐Oncology Association of Central America (AHOPCA) criteria. Multivariable logistic regression was performed to identify factors associated with early cardiac dysfunction.Results The incidence of early cardiotoxicity was 11.7%. Majority of patients who developed cardiotoxicity were asymptomatic. Undernutrition, assessed by WHO and AHOPCA criteria, was highly prevalent and significantly associated with cardiac dysfunction. Most affected patients showed recovery with medical management.Conclusions Undernourished children receiving anthracycline therapy for WT and hepatoblastoma are at increased risk of early cardiotoxicity. Routine nutritional assessment, early intervention and close cardiac monitoring may help mitigate acute cardiac toxicity in this vulnerable population.