Background: Dengue fever (DF) is a mosquito-borne viral illness in tropical region caused by the dengue virus, characterized by a wide range of clinical manifestations, from mild febrile illness to severe conditions such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Aim and Objectives: This study aimed to evaluate the clinical spectrum and laboratory profiles of children with dengue fever and dengue-like illness. Methods: A prospective observational study was conducted over a period of 18 months at a tertiary care hospital in central India, including 120 children aged 6 months to 18 years who presented with dengue-like illness. Clinical features, hematological parameters and serological status were documented and analyzed. Results: Out of 120 patients, 73 were males (60.8%) and 47 were females (39.2%). 26 (21.7%) were serologically confirmed by rapid diagnostic test (RDT) as dengue cases, while 94 (78.3%) were classified as dengue-like illness. Fever was the most common symptom in both groups, with retro-orbital pain, rash and ARDS more prevalent in dengue cases. Thrombocytopenia was observed in 91.2% of dengue cases, with severe thrombocytopenia in 19.2%. Leukopenia was noted in 69.2% of dengue cases. Mortality rates were 11.5% in dengue and 4.3% in dengue-like illness, primarily due to ARDS and DSS. Conclusion: The study highlights the diverse clinical spectrum of dengue fever and the similarities between serologically confirmed and unconfirmed cases, emphasizing the need for vigilant clinical management during dengue outbreaks. Despite the serological differences, standardized treatment protocols were effective, leading to similar clinical outcomes.