PIP: While it is unusual for children to present with finger clubbing, the authors began to frequently see such cases in the University of Malawi's Department of Pediatrics, College of Medicine. Clubbing was recognized in 52 children during February-May 1996. An 8-year-old boy died with a diagnosis of endomyocardial fibroelastosis. The remaining 51 children were aged 4 months to 12 years of mean age 37 months. 26 of the 31 children tested for infection with HIV were HIV-ELISA seropositive. A clinical diagnosis of pediatric AIDS according to the World Health Organization criteria was made in 35 cases. A provisional diagnosis of pulmonary tuberculosis was made in 29. Two of the older children had acid-fast bacilli in sputum; one was HIV-positive. Digital clubbing in Malawian children may be associated with chronic lung disease and HIV infection, presenting as early as infancy. In regions where childhood HIV infection is common and resources are scarce, clinical findings which improve diagnostic specificity could prove useful.