question: BACKGROUND Multiple investigators have described an increased incidence of thromboembolic events in SARS-CoV-2 infected individuals. Data concerning haemostatic complications in children hospitalised for COVID-19/MIS-C are scant. OBJECTIVES To share our experience in managing SARS-CoV-2 associated pro-coagulant state in hospitalised children. METHODS D-dimer values were recorded at diagnosis in children hospitalised for SARS-CoV-2 related manifestations. In moderately to critically ill patients and MIS-C cases, coagulation and inflammatory markers were checked at multiple time-points and median results were compared. Pro-thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases. RESULTS 35 patients were prospectively enrolled. D-dimer values did not discriminate COVID-19 of differing severity, whereas were markedly different between the COVID-19 and the MIS-C cohorts. In both cohorts, D-dimer and C Reactive Protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. 6 patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths, thrombotic or bleeding complications occurred. CONCLUSIONS COVID-19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS-C cases show laboratory signs of an inflammatory driven pro-coagulant status. Universal anticoagulant prophylaxis in hospitalised children with SARS-CoV-2 related manifestations is not warranted, but may be offered to patients with other pro-thrombotic risk factors in the context of a multi-modal therapeutic approach.