Pleural empyema was diagnosed in 69 infants and children over a ten-year period (1960 to 1970). In 52 of 69 cases, a specific organism was recovered by culture or gram stain of the pleural fluid. Staphylococcus organisms were the etiologic agent in 75% of these cases. Seven patients were treated by thoracocentesis alone. Closed-tube drainage and/or rib resection was done in 62 patients. An indicated decortication was done for three patients. The overall mortality was 7% with a 3.2% mortality since 1963 when staphylococcal specific antibiotics were introduced. Pleural empyema in infants and children can be well treated by adequate tube drainage and appropriate antibiotic therapy with a low morbidity and mortality, and pleural decortication is only rarely indicated in this age group.