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Objectives: The Brazilian Ministry of Health reports about 20,000 accidents per year caused by venomous snakes, mainly by the genus Bothrops (90.5%). Despite this high frequency, few studies have reported the clinical aspects of venomous snakebites in children in Brazil. This study evaluated the clinical aspects and outcome of bites caused by Bothrops spp snakes in children less than 14 years old. Case Series: From January 1984 to March 1999, 73 children (ages 1 y-14 y, median 9 y) were admitted after being bitten by Bothrops spp. The severity of envenoming was classified according to the recommendations of the Brazilian Ministry of Health. Upon hospital admission, 26.0% patients were classified as mild envenoming, 50.7% as moderate envenoming and 20.6% as severe envenoming. Two patients (2.7%) showed no signs of envenoming (dry bites). Most of the patients presented local manifestations, mainly indurated edema (95.9%), pain (94.5%), ecchymosis (74.0%) and local bleeding (21.9%). Systemic bleeding was observed in 9 patients, mainly gingival (9.6%). Before antivenom (AV) administration, blood coagulation disorders were observed in 62.5% (incoagulable blood in 39.3%) of the 56 children that received AV only in our hospital (mild accidents, median = 4 vials; moderate accidents, median = 7 vials; severe accidents, median = 10 vials; 1 vial = 10 mL of [Fab'.sub.2]). AV early reaction was observed in 44.6% of the cases (15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine antagonists H1 and H2), most of which were considered mild. Only one patient presented an acute severe early reaction. More than 76% of these 56 children received AV less than 6 h after the bite. The main clinical complications observed were local infections (15.1%) (including cellulitis, 9.6%, and abscesses, 5.5%), compartment syndrome (4.1%), gangrene (1.4%) and acute renal failure (1.4%). There were no significant differences with regard to severity of envenoming and the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75), or in the frequency of early AV reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infections was significantly greater in severe cases (p = 0.001, RR = 6.53, OR = 11.38). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenomation (p = 0.04, RR = 1.65, OR = 4.75). No deaths were observed. Conclusion: The prognosis can be very good as long as the children receive prompt medical care, including adequate AV prescription, fluid replacement to avoid renal ischemia, and correct treatment of the main complications., Bucaretchi F, Herrera SRF, Hyslop S, Baracat ECE, Vieira RJ. Deptos de Pediatria, Clinica Medica e Farmacologia, Centro de Controle de Intoxicacoes, Faculdade de Ciencias Medicas, Hospital de Clinicas, Universidade [...]