The optimal management of thoracic empyema in children is still controversial. In this retrospective study, we analyze our six-year experience in the management of empyema. From April 1995 to December 2001, 39 patients under age 6 years were admitted with the diagnosis of empyema. These patients were assigned by the method of empyema management to one of two groups (either the conservatively treated or surgically treated group). The surgical patients were divided on the basis of the timing of surgical intervention into either the early (within 8 hospital days) or late (beyond 8 hospital days) surgical group. There was no difference in total hospital stay between those treated conservatively (24.3 +/- 11.6 days) and surgically (24.5 +/- 7.9 days). Among the surgically treated patients, recipients of early surgical intervention had significantly shorter hospital stay (20.2 +/- 5.9 days) than those receiving late surgical intervention (30.1 +/- 6.5 days). Early surgical intervention in cases of thoracic empyema in young children can shorten hospitalization. These children should undergo surgery if their clinical course does not improve within one week.