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Introduction: The safety of hydroxyethyl starch (HES) forchildrenshould be paid more attention, which has been questioned for adult.The objective of this meta-analysis was to evaluate the safety of HES versusother fluids for volume expansionin pediatric patients.Methods:Randomized controlled trials (RCTs) involving pediatric patients who used 6% low-molecular-weight HES were searched from Pubmed, Embase database and Cochrane Library, published before January 2014.Two reviewers independently extracted the valid data, including the mortality, renal function, coagulationand blood loss,hemodynamic changes, the length of stay (LOS) in hospital and in intensive care unit (ICU).All data were analyzed by I2-test, and the results of statistical analysis were displayed in forest plots.Possible publication bias was tested by funnel plots.Bayesian analysis was performed using Win BUGS with fixed and random effects models developed by Dias.Results:A total of 13 RCTs involving 1,156 pediatric patients were finally included in this meta-analysis.Compared with other fluids, HES did not significantlyincrease mortality(RR=-0.01;95%CI: 0.05 to0.03;P=0.54;I2=6%),Creatinine value (Cr analyzed byI2-test: MD=1.81;95%CI:-0.35 to 3.98;P=0.10;I2=0 %;by Bayesian analysis :Fixed effect model MD=1.77;95%CI:-0.07 to 3.6;Random effects model MD=1.78;95%CI:-1.86 to 5.33),Activated Partial Thromboplastin Time (APTT:MD=0.01;95%CI:-1.05 to1.07;P=0.99;I2=42%) and blood loss (MD=17.72;95%CI:-41.27 to 5.82;P=0.10;I2=0%),but HES significantly decreased blood platelets count(MD=20.99;95%CI:-32.08 to-9.90;P=0.0002;I2=28%)and increased LOS in ICU (MD=0.94;95%CI:0.18to1.70;P=0.02;I2=46%).Conclusions : Compared with other fluids,6% low-molecular-weight HES does not seem to decrease the mortality or Creatinine in pediatric patients, and might have adverse effect on coagulation and increased LOS in ICU.We dont recommend HES as the first resuscitating fluid for pediatric patients.And more high quality RCTs and researches are needed to confirm its safety for children.