Background: Malaria is a major health problem in the world including in India. In malaria patients, prompt and accurate diagnosis is the key to effective disease management However the the disease pattern has changed over the years. it is important to be aware not only of disease pattern but also of any atypical presentations of malaria.

Methods: Observational study of Forty eight children with malaria presenting to casualty of a tertiary hospital in Delhi. The presenting features along with examination findings of these children were noted. The plasmodium species in these children was also identified.

Results: M:F ratio was 26:22 (p>0.05). P Vivax was seen in 44 and P falciparum in 2 cases. Both P.v and P.f. were seen in 2 patients. Intermittent fever with chills & rigors was the commonest presentation (89.5%) followed by vomiting (68,7%) & pain abdomen (39.5%). Remittent fever was rarely (2%) the presenting feature.Bleeding manifestation was seen only in 10.5%. On examination hepatomegaly & splenomegaly were commonest finding in approx. 90% patients followed by pallor in 77%. CNS involvement was seen in 6.5% patients all of whom were P.v. 4% of patients were comatosed at presentation. Only 2.0 % had icterus and none had convulsions in this study. The clinical features have also been detailed. based on the species type.

Conclusions:This study reports clinical profile of children with malaria in Delhi.. Knowledge of common presentations of malaria and of  its atypical features would lead to heightened clinical suspicion and subsequent timely diagnosis of malaria.