OBJECTIVES: Necrotizing soft tissue infections (NSTIs) are uncommon but potentially lethal infections that are well described in adults. Little is known about pediatric patients with NSTI. We sought to examine patients' characteristics, infection characteristics, treatment patterns, and outcomes of children with NSTIs using a large multicenter pediatric database. STUDY DESIGN: The Pediatric Health Information System database was used to examine demographics, diagnoses, procedures, medications, hospital charges, and outcomes of pediatric patients with NSTI during a 5-year period. RESULTS: A total of 334 patients with NSTI were identified. Times from admission to initial amputations and reconstructive surgeries were similar between the 2 groups, but nonsurvivors had a longer time from admission to their first debridement (median, 2 vs. 1 day, P = 0.03). On multivariate analysis, no other significant risk factors for increased mortality were identified, although increased age (P = 0.10), noncommercial insurance (P = 0.12), and use of corticosteroid therapy (P = 0.06) showed trends toward increased mortality. Diagnoses of streptococcal (P = 0.03) or staphylococcal infection (P = 0.03) were associated with a lower mortality on multivariate analysis. CONCLUSIONS: NSTIs are a rare but significant diseases in children. It seems that, as in the adult population, prompt surgical debridement is the most important intervention. Corticosteroid therapy may be associated with a worse prognosis.