Pelvic osteomyelitis is unusual in children. We retrospectively reviewed charts of patients with this infection seen at our institution. From 1998 to 2005, 31 patients with pelvic osteomyelitis were identified: 19 males and 12 females with an age range of 1.5 months to 17 years 9 months. Duration of illness prior to admission ranged from 1 day to 2.5 months. Chief complaints included nonspecific pain, fever, limp, and decreased weight bearing. Microorganisms isolated included Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella, Enterobacter cloacae, and Kingella kingae. Bones involved were acetabulum/ilium (22 patients), ischium (7 patients), and pubis (4 patients); 2 patients had several bones involved. Imaging studies performed included magnetic resonance imaging (21 patients), computed tomography (14 patients), and nuclear bone scan (25 patients). Our study, the largest contemporary series of pediatric pelvic osteomyelitis from one institution, highlights the consequences of prolonged duration of illness and delayed diagnosis.