Background: Pleural effusion is the pathological accumulation of fluid in the pleural space. Pediatric pleural effusion usually present with a dynamic profile over time both in terms of its etiology and the causative organisms. This study aimed to provide a description of the clinic-etiological profile of these patients with an emphasis to identify the bacteriological spectrum of the pleural fluid for an appropriate, and timely management of these children. Objectives: To study the clinical profile of hospitalised children 0-19years with pleural effusion. Materials and methods: A prospective hospital based observational study was conducted on 133 children diagnosed with pleural effusion to study its etiology and clinic-bacteriological profile in a tertiary care hospital in north India. Results: The most common etiology of pleural effusion observed in the study was tuberculosis (21.1%) followed by empyema (20.3%). Maximum patients were in the age group of 6-12 years (36.8%) with males (54.1%) being affected more frequently affected. Exudative effusion was more common than transudative effusion. Fever and cough were the most common symptoms. Right sided effusion was more common (49.6%).Parenchymal disease was associated in 22.6% of the exudative effusion. The most common organism isolated was Staphylococcus aureus followed by Streptococcus pneumonia. Significant association was seen between age and the etiology of pleural effusion Conclusion: Pleural effusion in children can have varied etiologies and proper clinical history, examination and evaluation of the characteristics of pleural fluid can help in identifying the etiology of pleural effusion and selecting the best treatment approach for a favourable outcome.