The epidemiology of paediatric osteomyelitis in a single health district in England from 2000 to 2005 was compared to that from two prior timeframes. Fifty-three children were diagnosed with acute haematological osteomyelitis (AHO) and were compared to 36 and 49 patients from 1982 to 1986 and 1947 to 1951 respectively. The annual incidence of AHO in the most recent period was 0.4 patients per 100 000 of the total population. The mean age of presentation was 40 months (ranging between 0.5 and 179). This was statistically significantly less than the two earlier timeframes. Staphylococcus species was the commonest isolated organism. Plain radiography had a pickup rate of 32.7%. Second line investigation of nuclear medicine and magnetic resonance imaging had greater sensitivities of 78.8% and 75% respectively. The rate of surgical intervention was halved comparing 2000-05 to 1947-51. We were unable to unequivocally demonstrate a decreased incidence AHO in our region. However the review does confirm that the clinical approach to diagnosing and treating AHO had changed over the years.