One of the components of the current WHO strategy to fight malaria is early recognition and prompt and appropriate treatment. We investigated determinants of delay in seeking early and appropriate malaria treatment for children (0-5 years) in Ohaji/Egbema, South Eastern Nigeria. Data was collected using structured pre-tested questionnaires elicited in the local language (Igbo) to 738 consenting mothers within the child bearing age (15-49 years). About twenty-two percent (22%) of the respondents sought treatment within 24 h for their children with malaria and were excluded from further investigation. More than half of the remaining respondents (51.5%) delayed in seeking treatment because they had to watch their children for some days, while 21.4% were due to financial difficulties. The age, parity, marital status/type of marriage and educational attainment of the mothers including family social-economic status were found to be statistically related to delay in seeking appropriate treatment (P < 0.05). Wrong first line treatment choices by the respondents also contributed to this delay. These results underscore the need to improve awareness of mothers and caregivers on the need and ways of seeking early, appropriate and effective treatment for their children who have malaria. This is very important if the WHO strategy of early recognition, prompt and appropriate treatment is to be effective so as to sufficiently reduce mortality and morbidity due to malaria among children in endemic rural areas. It will also aid in the proper management and treatment of other childhood febrile illnesses.