Objective　To explore the diagnosis and treatment of empyema in children. Method　The clinical data of empyema in 49 children were reviewed and analyzed. Results　In the 49 cases (25 males and 24 females) aged 4.7±3.4 years, the common symptoms were fever, shortness of breath and coughing. There were 11 cases of positive blood culture, 17 cases of positive pleural fluid culture, 3 cases of positive blood and pleural fluid culture. Streptococcus pneumoniae was the most common pathogenic bacteria. All 49 patients were given systemic antibiotics and closed thoracic drainage. In addition, 26 cases were treated with urokinase and intrapleural fibrinolytic therapy and 6 cases were treated surgically. The prognosis was good and there was no death. Conclusion　Pneumococcal infection is most common in children with empyema. Systemic antibiotics plus closed thoracic drainage and urokinase are effective, and some require surgical treatment.