Clinical findings, roentgenograms, computed axial tomography (CT scan), radionuclide studies, and management are reviewed in seven children with pyogenic sacroiliitis (PS). High suspicion and complete examination of the pelvis and sacroiliac (SI) joint, including flexion, abduction, external rotation, and extension (FABERE) test, are essential for diagnosis. Although initial roentgenograms may be negative, CT scan will show changes indicating involvement of the SI joint. Sequential technetium and gallium scans are valuable in localizing PS. Blood cultures and direct aspiration of the SI joint will identify the infecting organism. Patients are initially treated with intravenous antibiotics. Surgical treatment is reserved for patients with advanced stage of PS.