This prospective observational study was conducted in the Department of Pediatrics, Amaltas Institute of Medical Sciences, Dewas between March 2016 to August 2017. Patients were classified on the basis of detailed history, clinical examination, ECG record, chest x-ray, Weight-for-Height, age of diagnosis, follow up and other relevant investigations pertaining to the case. The correlation among the clinical examination, ECG & chest x-ray findings were studied. The predictive values of development of complications during the follow-up period by these 3 parameters were observed. Sex distribution, age of diagnosis, clinical examination, ECG, chest x-ray, weight for height, types of VSDs and development of complication on follow up of these patients were analyzed and classified accordingly. The complications of VSD are biventricular hypertrophy, congestive cardiac failure, Pulmonary hypertension, Eisenmenger Syndrome, aortic insufficiency, infective endocarditis& heart block (rare). In our study group 24/56 (42.8%) patients presented with biventricular hypertrophy & all of them were large sized VSDs. Out of25 large sized VSDs, 20 (35.7%) patients had congestive cardiac failure. 35 out of56 had pulmonary hypertension (62.5%), as evident by ECG (P pulmonale in lead II), clinical examination (palpable P2 & loud P2 on auscultation) & chest x-ray (enlarged Pulmonary Artery segment). 1 Patient out of 56 developed Eisenmenger Syndrome (1.7%). 1 Patient out of 56 developed infective endocarditis (1.7%). Prospective Observational Study. A detailed clinical history, clinic-radiological profile and ECG are very helpful in assessing severity and development of complications. Early diagnosis is required to aid the physician in referral of the patient to a specialized center for early surgery. Early diagnosis, proper referral as discussed above & management will help in preventing the associated complications, thereby reducing the mortality and morbidity in these children and improve their quality of life