OBJECTIVES: To compare the clinical course and complications of snake bite in children and adults. METHODS: A retrospective review of 66 patients (28 children and 38 adults) admitted after snake bites for management at the Prince Abdullah Hospital in Bisha, in the south western part of Saudi Arabia, during the period May 1992 to May 1995. RESULTS: No significant difference was found in time of bite, site of bite, and sex preference between adults and children. Local complications, such as tissue necrosis, were commoner in children (14%) than in adults (5%). Systemic manifestations were also more commonly seen in children than in adults; this is possibly due to a higher ratio of injected venom to body mass in children. Leukocytosis was seen in 54% of children (adults 13%), a low haemoglobin concentration in 14% of children (adults 11%), prolonged prothrombin and partial thromboplastin times in 41% of children (adults 16%), while a high creatine phosphokinase was seen in 31% of children compared with 17% of adults. CONCLUSIONS: Children seem to have more serious local and systemic complications than adults and this may indicate the need to use a higher dose of antivenom than that being used at present.