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Children living in urban informal settlements are disproportionately exposed to environmental hazards associated with polluted river water or degraded river stream systems. Regrettably, many communities are often not aware of the dangers degraded river systems pose both on environment and public health of the citizens living in their vicinity. Hence, this study assessed community perceptions of children’s vulnerability to environmental hazards in Umlazi Township, KwaZulu-Natal, and integrated these perceptions with targeted environmental exposure measurements. A household questionnaire (n = 190) was administered to adult residents to examine perceived stream conditions, health and safety risks, children’s exposure pathways, water governance, and community environmental awareness. Composite indices were developed to quantify children’s vulnerability, environmental hazard perception, knowledge and awareness, and governance barriers, and analyzed using descriptive and inferential statistics. To contextualize perceived risks, surface water samples were analyzed for select pharmaceutical, biological and chemical contaminants, such as Escherichia coli, total coliforms, phosphate, and nitrate. The pharmaceutical ecological risk was assessed using cumulative risk quotient and toxic unit approaches, while microbial and nutrient contamination were evaluated using guideline-based risk classifications. Results indicated that poor perceived stream condition, proximity to streams, governance barriers, and negative community attitudes were significantly associated with higher perceived vulnerability of children towards health risks. Environmental analyses confirmed elevated microbial contamination, nutrient enrichment, and high pharmaceutical mixture toxicity, supporting community concerns regarding unsafe stream environments. The convergence of social perceptions and environmental exposure evidence highlights compounded ecological and public health risks for children in the Umlazi Township and underscores the need for integrated interventions addressing wastewater management, sanitation, and child-focused urban planning.