Background and Objectives: Pleural effusion is an abnormality that results from collection of fluid in the pleural space. The etiological mechanisms of pleural effusion is considerably different in children and adults. Clinical presentations are variable and dependent on the underlying disease process, size, and site of effusion. The most important investigation to identify the cause of effusion is analyzing the pleural fluid cytologically and biochemically. This also helps to classify an effusion into exudate or transudate which is indicative of the underlying pathophysiological process involved. Knowledge of the clinical profile of effusion in children would help in adoption of an optimal diagnostic & therapeutic approach. Based on this background, we studied clinico-radiological and etiological pattern of pleural effusion at our hospital. Methodology: We conducted a prospective observational study over 1 year from January 2017 to December 2017 at department of Pediatrics, ANMMCH, Gaya, Bihar which is a tertiary care level teaching hospital. Children of >1 year to <15 years with unilateral or bilateral pleural effusion diagnosed on the basis of clinical features and/or imaging studies were included in our study. Results: Over the study period, we enrolled 42 children in our study. Mean age of presentation was 6.3±3.8 years. Mean weight on admission was 18.1± 5.2 kg. Male (23): female (19) ratio was 1.21:1. The most common symptom was breathing difficulty (83.3%), followed by loss of appetite (76.2%), fever (69%), cough (59.5%) and weight loss (40.5%). Right sided effusion (n = 18, 42.9%) was more common than left side (n= 11, 26.2%), while the effusion was bilateral in 13 (30.9%) children. Majority of the children had exudative pleural effusion as compared to transudative pleural effusion (54.8% vs 45.2%). The three most common causes of pediatric pleural effusion (nearly 50%) were parapneumonic, tubercular and nephrotic syndrome. Pleural biopsy was needed in only in 2 (4.8%) children and we were able to diagnose more than 95% children with simple biochemical, molecular and cytological examination. Conclusion: Pleural effusion was commoner in young school going children. Parapneumonic effusion, tubercular effusion and effusion due to nephrotic syndrome were the most common causes. Breathing difficulty was the most common presenting feature. Majority of children had exudative effusion. In most cases, underlying aetiology could be identified by simple biochemical, cytological and molecular studies.