The spelling "Paxtang" is from the original Indian name Peshtank, which meant "standing water".

On March 4, 1785, Lancaster County was split to form Dauphin County, named for the Dauphin of France, heir apparent to the French throne, whose country the area government wanted to honor for its assistance in the Revolutionary War.

[4] The John Ayres House was listed on the National Register of Historic Places in 1979.

[5] Middle Paxton Township is in central and western Dauphin County, bordered to the southwest and west by the Susquehanna River.

The borough of Dauphin is in the western part of the township on the Susquehanna River, but is a separate municipality.

The township has unincorporated communities, including Ellendale Forge, Fort Hunter, Heckton and Singersville.