Background: The diagnosis and management of anemia largely depends on clinical assessment for pallor. Pallor is explained as decreased colour of the skin and mucous membranes. Aim: the aim of this study was to evaluate the accuracy of pallor in the diagnosis of anemia in children aged 6 months to 5 years. Material and methods: A case control study was conducted in the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India for 15 Months . 200 children in the age group of 6 months to 5 years were included in the study. Pallor was assessed in four sites namely conjunctiva, tongue, nail bed and palm under day light. After history and physical examination, blood sample was taken for haemoglobin estimation and other relevant investigations. All samples were collected within 3 hours of physical examination. Anemia was diagnosed according to WHO criterion (Hb<11 g/dl in 6 months- 5 years).7 Anemia was divided into mild (Hb: 10-10.99 g/dl), moderate (Hb: 7-9.99 g/dl) and severe (Hb: <7g/dl). Results: Two hundred patients were included in the study of which 100 were assigned as cases (pallor-study group) and 100 as controls (no pallor group). Both the groups were matched in terms of age and gender. There were 72 male and 28 females in pallor group whereas 64 and 36 in non pallor group. Age distribution as<1 year, 1-3 years and 3-5 years in 35%, 28% and 37% respectively in pallor group. In control group these were 25%, 44% and 31%. Out of 100 patients with pallor, 80 had anemia, whereas non-pallor control group had only 25 anemics. Sensitivity and specificity of pallor for anemia detection were 74.6% and 78.4% respectively. Positive predictive value and negative predictive values stand at 81.39% and 69.77% respectively. The mean hemoglobin in pallor group was 9.87±2.7 g/dl and in non-pallor group it was 11.95±1.12 g/dl. In the study group (with pallor), pallor was identified in 70 (70%) in conjunctiva, 55 (55%) in tongue, 74(74%) in nailbed and 84 (84%) in palm. 52 cases had pallor in all 4 sites. Maximum sensitivity, specificity and predictive values were found for palmar pallor. Tongue turned out to be least sensitive for identifying pallor. All the four sites were found to have statistically significant correlation with anemia (p value<0.001). Sensitivity of pallor in all the four sites was found to have positive correlation with severity of anemia. To detect severe anemia sensitivity of conjunctival pallor was 100%. Iron deficiency anemia was the etiology in 80% of cases. Hemolytic anemia and leukemia in 2% each, chronic diseases and malaria in 2%, others were the causes in 10%. Other causes included megaloblastic anemia, hypothyroidism, autoimmune hepatitis, CMV infection and acute bleeding. Pallor at each site was tried to correlate with etiology . However, no statistically significant correlation was found. Conclusion: Pallor was found to be very useful in detecting anemia, also it had more specific than sensitive value. The best predictor site for pallor for diagnosing anemia was palm.