Toxic shock syndrome (TSS), a toxin-mediated disease, is the most common cause of unexpected mortality in children with small burns. It is a diagnosis that is often missed because of non-specific signs and an ability to mimic other childhood illnesses. Any child with a pyrexia greater than 38.9 degrees C, a rash, or a sudden change in clinical condition within a few days of a burn injury should be monitored closely for TSS. If there is co-incident hyponatraemia or lymphopaenia, or if there is any deterioration in clinical condition, the child should be managed with anti-staphylococcal and streptococcal antibiotics and passive immunity for toxins provided by fresh frozen plasma (FFP) or intravenous immunoglobulin (IVIG). It is essential that all paediatric and emergency departments accepting children with burns are aware of the symptoms, signs and early management of TSS.