Background: Regional anesthesia in pediatric surgery alone or combination with light general anesthesia provides several advantages, the most significant is intra-and post-operative pain relief. Aim of the work: This study aimed to compare spinal to caudal anesthesia in children undergoing lower abdominal surgeries regarding [sensory and motor block as a primary outcome], hemodynamics and postoperative pain as a secondary outcome. Patients and Methods: This study was a prospective randomized comparative clinical single-blind study. It included 40 children [ASA I or II] of both sexes, aged [3-9 years] undergoing lower abdominal surgeries. Patients were randomly assigned into one of two groups [20 patients in each group]. group [S] undergo spinal anesthesia, group [C] undergoes caudal anesthesia. To assess the following parameters; sensory and motor block, heart rate, mean arterial blood pressure and postoperative pain. Results: Spinal anesthesia has a rapid onset of sensory block, more intensity than caudal anesthesia, but of shorter duration. Caudal anesthesia provides more time of motor block than spinal anesthesia. There was no statistically significant difference between groups regarding mean arterial pressure, but caudal anesthesia has more tachycardia than spinal anesthesia, and caudal anesthesia provides better postoperative analgesia more than spinal anesthesia. Conclusion: Regional anesthesia in pediatrics is an effective and safe option. Caudal and spinal are both effective, however caudal have relatively more duration of postoperative analgesia and motor block than spinal anesthesia.