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INTRODUCTION:Megaloblastic anemia is an anemia that results from inhibition of DNA synthesis. The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically a deficiency of vitamin B12 or folic acid or both. Megaloblastic anemia has a slow onset, the symptoms develop rather slowly , especially when compared to that of other anemias. It has varied clinical manifestations. AIM: To study various clinical manifestations of megaloblastic anemia in children. To describe the blood smear and bone marrow morphology characteristics of megaloblastic anemia. MATERIALS AND METHODS: A study of 124 cases of megaloblastic anemia in children below 15 years of age during 7 years (January 2006 to December 2012) was conducted at Niloufer hospital. Clinical findings were obtained and statistical analysis of the data was done. RESULTS: More than half of the patients presented with mild anemia and pallor. Other presenting features included fever (14.4%), splenomegaly (23.4%) and bleeding manifestations (15.3%). CONCLUSION: The study concludes that pallor is not the only presenting complaint of megaloblastic anemia. It can have varied clinical presentations like hepato splenomegaly and thrombocytopenia with bleeding manifestations. Prompt diagnosis is especially important as megaloblastic anemia is a completely curable condition.