BackgroundPediatric autopsy is an effective tool for identifying the cause and the manner of death in suspicious childhood deaths. Aim of the studyTo explore the pattern of suspicious childhood deaths during the recent years (2020–2021) in the Egyptian community and to identify the risk factors to avoid them during the childhood period. Subjects and methodsOne hundred and fifty Egyptian suspicious child death cadavers (less than 18 years old) were autopsied in Zeinhom Morgue during one-year period (2020–2021). Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed. ResultsIdentity was known in 77.3% of the studied cases, and male to female ratio was 2.2:1. Most of cases were recruited from Cairo and Giza governorates. Adolescents contributed to about one third of the cases. Deaths at home or in hospital were more than outdoor deaths. Seasonal variation was observed as more cases were autopsied during spring and summer. Homicidal deaths (32%) were more in toddlers and adolescents mostly by blunt trauma (58.3%) with signs of violence and resistance or child abuse, mainly in males. The perpetrator was known to be a family member in more than half of the studied cases (56.25%). Accidental deaths (17.3%) were mainly by firearm injuries or poisoning. Suicidal deaths (13.3%) were represented more in adolescents by hanging or by aluminum phosphide poisoning. Natural deaths (13.3%) by bronchopneumonia or leukemia were found in neonates and adolescents. Sudden infant death syndrome (SIDS) (6.7%) was diagnosed by exclusion among neonates and infants only during spring, with equal gender distribution (1:1). Malpractice (6%) leads to death by sepsis or hemorrhage. ConclusionsAll manners of death contribute to suspicious death during childhood period, especially during summer and spring. Family members are the perpetrator for most of accidental, homicidal or suicidal deaths. RecommendationsTraining courses are recommended to parents for proper care and protection of their children to avoid violence, abuse and accidents at home or outdoor.