Over a 2-year period, 16 children with parapneumonic effusions were identified at the Royal Alexandra Hospital for Sick Children, Brighton. The case notes of these children were retrospectively reviewed. The presenting symptoms caused diagnostic confusion in two children resulting in negative laparotomies. Isolation of the infecting organism from the parapneumonic group was comparable to other authors, 6 out of 16 patients (53%); however, when the yield from pleural aspirates is compared, there was only one positive culture out of six (17%). Possibilities for improving this disappointing isolation rate are discussed. Two children with the longest history of symptoms and shortest chest drainage time had long term problems. Diagnostic tap, which carries little risk, and drainage, if required, should be performed early.