A high index of suspicion for spinal infection and an appropriate and prompt diagnosis are essential for the treatment of pediatric spinal infections. A 3-week course of antibiotics and supportive therapy is effective in the majority of cases of discitis, the most common pediatric spinal infection. Patients who are not toxic may be treated with bracing, or with casting alone in many cases. Neurologic deficit or a failure to respond to early treatment requires more aggressive measures, including biopsy or surgical debridement. It is essential to diagnose rare but serious conditions such as epidural abscess, tuberculosis, or opportunistic infections in patients at risk. The authors stress that clinical evaluation and appropriate diagnosis are critical for prevention of permanent neurologic damage or late bony deformity.