Background: Pleural effusions with their different types represent an important part of the activity in the intensive care unit and general wards as well. Infection is the most common cause of pediatric pleural effusions. Currently available treatment options for pediatric parapeumonic effusion and empyema include antibiotics alone or in combination with chest tube drainage, fibrinolytic agents and surgery (video-assisted thoracoscopic surgery or open thoracotomy with decortication). Morbidity and Mortality are related to etiology of pleural effusions, presence of complications and need for intensive care unit admission.Objectives: To assess the modalities and outcome of management of pleural effusions in Children Hospital, Cairo University.Methods: An observational descriptive study included patients of both sexes up to the age of 12 years who were presented with pleural effusions and admitted to Cairo University Pediatric Hospital during the period from September, 2012 till April, 2013.Results: Out of 35 patients admitted, 22 patients (62.9%) were males and 13 patients (37.1%) were females. Infection etiology represented 80% of the total percentage of cases (empyema 42.9% and parapneumonic effusions 37.1%).23 patients (65.7%) needed drainage procedures (22 patients by chest tubes and one patients needed surgical decortication), whereas 12 patients (34.3%) needed medical treatment only. Drainage was significantly related to increased length of stay, respiratory distress on presentation, final diagnosis ( mainly empyema), presence of complications, need for intensive care unit admission and large effusions.Length of stay was found significantly in direct proportion to complications and intensive care admission. It was also significantly larger in drainage management than medical management.Mortality was accounted for 17.1% of all patients. It was significantly associated with intensive care admission, mechanical ventilation and presence of complications such as septicemia, respiratory failure and pneumothoraxConclusion: Infection etiology was the leading cause of pleural effusions. Chest tube drainage was the main modality of management in our study. Outcome and Mortality were significantly related to intensive care admission, mechanical ventilation and presence of complications.