Aim: To find whether there is an association of clinical parameters, dental attendance pattern, oral hygiene, and dietary practices with the presence of active caries lesions among children with early childhood caries (ECC). Materials and methods: In this cross-sectional study, 171 children of 3–5 years of age with at least one decayed/filled tooth surface were examined. The presence or absence of visible plaque and decayed, missing, or filled-surface (dmfs) score were recorded. Each tooth surface was scored as per International Caries Detection and Assessment System (ICDAS) II criteria followed by supplemental lesion activity assessment (LAA) criteria, which was used to classify the lesions as active/inactive. A structured questionnaire regarding oral hygiene, dietary practices, and dental visit frequency was filled by parents of the children. Results: Of the 740 surfaces examined, 82.6% were active caries lesions. Previous dental visit, sweet score, presence of visible plaque, and ICDAS score above 4 were significantly associated with active carious surfaces. Conclusion: Factors associated with active caries lesions are the presence of visible plaque on the tooth surface, cavitation extending to dentin, and higher frequency of sugar consumption by the child. Clinical significance: Improper oral health practices can contribute to the activity of the caries lesions. Parental education on oral health practices, particularly plaque control measures, decreasing sugar exposures in the diet, and regular visits to the dentist for completion of the restorative therapy may help to render the lesions inactive.