Aim: to assess the efficacy of hypertonic saline versus mannitol in the treatment of raised intracranial tension in children. Material and methods: This comparative and observational study was done the Upgraded Department of Paediatrics, Patna Medical College and Hospital, Patna, Bihar, India, for six Months. Total 220 Children aged 2 to 18 years admitted to the emergency Department of Pediatrics during the study period with clinical symptoms and signs of raised intracranial pressure were included in this study. Group A: 110 patients treated with mannitol. Group B: 110 patients treated with 3% hypertonic saline. Loading dose (5ml/kg) was followed by maintenance dose (2 ml/kg) in every 6 h in both groups for two days (osmolarity of mannitol and 3% hypertonic saline are almost same i.e. 1100 mOsm/l and 1098 mOsm/l, respectively). Results: Decrease in MAP was highly significant (P<0.001) at 0 h in males 0 h, 6 h in females, and moderately significant at 12 h, 36 h in females and significant(P<0.05) at 6, 24h, 42h in males of Group B. Decrease in coma hours was a highly significant finding (P<0.001) in Group B. In Group B, serum sodium and chloride increased significantly but remained within acceptable limits. There was no difference in osmolality and mortality (fisher Z). 3% hypertonic saline was more efficacious than mannitol in the initial 12 h and equally or more efficacious than mannitol therapy later. Decrease in coma hours was a significant additional finding in the group treated with 3% hypertonic saline. Group B. Change in blood biochemistry was within acceptable limits in Group B. Conclusion: the mannitol has several side effects, 3% hypertonic saline is a safe and effective alternative inmanaging cerebral edema.