Thoracic empyema is a life-threatening condition in paediatric surgical practice and the appropriate management still remains controversial. The authors reviewed 79 (37 boys, 42 girls) cases of empyema thoracis who underwent thoracotomy and decortication between 1990 and 2005. The initial diagnosis based on history, physical examination and radiology was confirmed by thoracentesis. Fever, cough and dyspnoea were the most common presenting symptoms. In all cases aerobic cultures were performed and Staphylococcus aureus was the most common microorganism isolated. All patients except three received antibiotics and tube drainage as an initial treatment. The decision for early decortication was based on persistence of fever, dyspnoea, air leakage and lack of resolution on CT scan, in spite of medical therapy and tube drainage, at the end of 10 days. All but one with wound dehiscence showed rapid recovery and they were discharged on the fifth to eighth postoperative days. In conclusion, early decortication is a safe and curative treatment in childhood empyema thoracis with low morbidity.