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The aim is to study IL‐10 polymorphisms and IL‐10 level and assess their relation to T‐cell subsets in childhood immune thrombocytopenia (ITP). In all, 40 (25 acute, 15 chronic) ITP child patients were investigated at time of presentation, compared to 15 healthy, age‐ and gender‐matched controls and followed up for 1 year to determine chronic cases. Studying the effect of IL‐10 promoter polymorphism was done by PCR‐RFLP, IL‐10 level was determined by ELISA, natural killer cells and T‐cell subsets were evaluated by flow cytometry. Subjects with IL‐10 promoter (1082 AA and 592 AA) genotypes had lower IL‐10 levels and had lower CD4%, higher CD8%, lower CD4/CD8 ratio and lower T‐reg%. IL‐10 polymorphisms had no effect on NK%. IL‐10 serum levels and IL‐10 promoter polymorphic genotype frequencies are not different between ITP cases and controls; however, in ITP patients, IL‐10 promoter (1082 AA and 592 AA) genotypes and associated lower CD4, higher CD8, lower CD4/CD8 ratio is associated with more severe thrombocytopenia at presentation and had a poorer response to first‐line treatment. Patients with lower T‐reg cells had a higher tendency to develop chronic ITP. IL‐10 level and polymorphisms as well as disturbed T‐cell subsets percentages are demonstrable effectors of immune dysfunction in ITP and can affect the presentation and outcome of childhood ITP. [ABSTRACT FROM AUTHOR]