Physicians vary considerably in their opinion as to the duration of hospitalization and degree of surgical intervention for children with pneumococcal empyema. The development of pneumatoceles and persistence of fever or loculated pleural fluid are causes of debate and concern. We reviewed the records of 21 children with confirmed pneumococcal pneumonia. Ten of the 12 with no pleural fluid became afebrile within 48 hours of appropriate antibiotic therapy, whereas the nine with empyema remained febrile an average of 7.1 days (minimum estimate) in spite of documented sterile cultures within 24 hour in five of the patients. Although chest tube and thoracentesis drainage could not remove all the pleural fluid, and pneumatoceles developed in five of the nine children, long-term follow-up studies including chest roentgenograms and pulmonary function testing demonstrated a gradual but complete recovery that did not require long-term hospitalization, continued parenteral antibiotic therapy, or invasive surgical procedures.