Background: Chronic liver illnesses can be caused by a variety of factors, including metabolic, genetic, drug-induced, inflammatory, structural, dietary, and immunological factors. Even with Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI), liver fibrosis makes diagnostic imaging difficult in chronic liver injury. Percutaneous liver biopsy is the gold standard for diagnosing, grading, and monitoring liver fibrosis in children, but it is painful, invasive, requires heavy sedation, and has numerous complications such as bleeding. Objectives: The aim of the current work was to assess and measure liver stiffness in children with chronic liver disease using real-time elastography (RTE), compare the results to histopathological findings obtained after performing a percutaneous liver biopsy, and investigate the availability of noninvasive safe liver elastography as a future replacement for this invasive tool in the evaluation and grading of liver fibrosis. Patients and methods: This hospital-based cross-sectional comparative study included a total of 30 individuals with chronic liver disease of various etiologies with age ranged from 4-16 years, attending at Department of Pediatric, Sohag University Hospitals. This study was conducted between January 2017 to December 2019. A control group of ten healthy people was also included in the investigation. Results:  The degree of liver stiffness measured by the last ultrasonic elastography was greater in the patient group than in the control group, with a statistically significant difference between the two groups. Except for F0-F1 and F3-F4, there was a substantial relationship between fibrosis stage and liver stiffness assessment by sonoelastography, where the difference was significant between every two individual groups. There was a strong link between biopsy diagnosis and liver stiffness measurement. Conclusion: It could be concluded that in adults, ultrasonic elastography is a well-established approach for assessing liver fibrosis. The utility of elastography in the follow-up of children with chronic liver disease might be increased.