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Objective To explore the clinical significance of platelet-related parameters in children with chronic spontaneous urticaria (CSU). Methods Sixty-eight children with CSU and 68 children without CSU were enrolled. The differences in platelet-related parameters, including platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW), were compared between the two groups. The association of the disease course and disease severity with platelet-related parameters were analyzed in CSU children. Results PLT levels were significantly higher in children with CSU than in that without CSU (t=3.96, P<0.001). In contrast, children with CSU had significantly lower MPV (t=-5.99, P<0.001) and PDW (t=-8.12, P<0.001) than children without CSU. Moreover, severity of disease did not correlated with PLT, MPV and PDW (P>0.05). However, the disease course correlated positively with MPV (r=0.26, P=0.034) and PDW (r=0.35, P=0.004), but not with PLT levels (r=0.02, P=0.875), in children with CSU.PLT levels negatively correlated with MPV (r=-0.41, P<0.05) and PDW (r=-0.34, P<0.05). Conclusions Platelet-related parameters can reflect the occurrence and development of CSU in children. MPV and PDW can serve as indicators to evaluate platelet activation and predictors of the course of CSU in children.