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Necrotizing fasciitis (NF) is a rapidly progressing bacterial infection of the subcutaneous tissue that can be life threatening. Without prompt diagnosis and treatment, it can lead to septic shock, organ failure and death. Due to the rarity of this disease in the pediatric population and the fact that initial symptoms are frequently nonspecific, NF in children is often misdiagnosed as cellulitis, which delays the correct treatment. Physicians must maintain a high index of suspicion and keep NF in mind because rapid surgical debridement is necessary to reduce morbidity and mortality. The purpose of this article is to better characterize what is currently known about NF within the pediatric population. In this article, the microbiology, pathophysiology, clinical manifestations, diagnosis, and treatment of pediatric NF are reviewed, and key differences between adult and pediatric NF are highlighted.