Acute hematogenous osteomyelitis is an infection of bone and marrow in which the offending organism is transmitted to the area via the bloodstream. The pathophysiology of the infection is closely related to the vascular anatomy of bone, which is age-dependent. Because of certain anatomic features of bone during infancy and childhood, the disease is most prevalent at these times. The diagnosis must be made clinically, although cultures and bone imaging may be of great help. The key to successful therapy is early and sufficiently long administration of appropriate antibiotics. Judicious use of surgical drainage is based on the specific clinical situation.