The purpose of this study was to assess the association of bottle feeding and oral hygiene practices with the severity of caries among 3 to 5-year-old children with Early Childhood Caries (ECC). This cross-sectional study was carried out on pediatric dental patients with ECC attending a public university hospital. The parents or guardians were interviewed for the bottle-feeding pattern and oral hygiene practices followed by a clinical dental examination of their children with ECC. Data analysis was done using Chi squared test. Out of 32 children, 69% had severe early childhood caries with mean dft of 8.88. In this study, 87.5% of the subjects had a history of bottle feeding, with 53.1% still being bottle fed at the time of study. Current bottle-feeding habit was found to be statistically significant with the severity of caries (p=0.021). Majority (69 %) of the children were introduced to tooth brushing only after 1 year of age. About 40% of the children consumed either pre-chewed rice and/or shared spoons or feeding utensils with their parents or siblings but there was no significant association with the severity of caries (p=1.00). Because of its association with ECC, prolonged bottle feeding is significantly associated with the severity of caries in our study population. Besides, vertical and horizontal transmission of bacteria was also a risk factor for ECC, but it did not show any significant association with severity of ECC.