Four children had vertebral osteomyelitis due to Staphylococcus aureus. Abdominal signs and fever were frequent clinical manifestations. Back pain was an uncommon symptom except as a late manifestation in one patient. The portal of entry of the organism generally was not apparent. Location of infection was in the lower thoracic and lumbar spine. Diagnosis was based on roentgenographic changes, radionuclide imaging, and bacteriologic corroboration. We conclude that symptoms and signs of vertebral osteomyelitis in children can be atypical and that a diligent attempt to rapidly diagnose and promptly treat this condition will prevent orthopedic and neurologic sequelae.