To obtain information to guide the management of children and early adolescents with apparent spontaneous pneumothorax the medical records of all patients over the age of 5 years presenting with this condition over a 25-yr period were reviewed. Twelve patients had a pneumothorax not associated with an acute episode of asthma. Six of these underwent thoracotomy at first presentation. Of the six who were initially treated conservatively five had a recurrence on the ipsilateral side. Seven patients developed a pneumothorax during an acute episode of asthma and none had a recurrence. Early intervention by either thoracotomy or some form of closed pleurodesis should be considered in paediatric patients presenting with an apparent spontaneous pneumothorax not associated with an acute episode of asthma. Pneumothorax complicating an acute episode of asthma is rare in the paediatric age group and is unlikely to recur.