Association of childhood psoriasis with metabolic syndrome has not been studied well. TNF-alfa contributes to the inflammation seen in metabolic syndrome, and recently etanercept has shown to reduce the levels of inflammatory markers. Assessment of prevalence of metabolic syndrome in juvenile psoriasis patients in Kuwait. We included 236 patients with moderate to severe psoriasis below 18 years treated for at least 24 weeks with TNF inhibitors (Group A), and equal number of age and sex matched cases treated with conventional medications (Group B). The metabolic syndrome (MBS) was defined according to the International Diabetes Foundation (IDF 2007 criteria for children). Increased waist circumference was seen in 56.77% of cases in Group A. Triglyceridemia was less frequent in Group A. MBS was higher in Group B [41·52% vs. 50·42%, odds ratio (OR) 1·76, 95% CI 1.19-2.41; p = .005]. Psoriasis is associated with higher prevalence of metabolic syndrome in children. Six months of anti TNF treatment showed lesser association with metabolic syndrome. With fasting blood glucose, and serum TG seen in significantly lesser number of patients in this group.