Medical records of 60 patients with bacteremia caused by group A streptococci who were treated at the Yale-New Haven (Conn) Hospital from 1973 to 1986 and the Boston Children's Hospital Medical Center from 1977 to 1984 were reviewed. Seven children (12%) were immunocompromised, seven (12%) had varicella, and two (3%) had cavernous hemangiomas. Fifty-two children (87%) had an identifiable focus of infection. The most commonly documented sources of bacteremia were in the skin (22 children) and the respiratory tract (19 children). Metastatic foci of infection included osteomyelitis (nine children), septic arthritis (eight children), and meningitis (three children). Seven episodes were nosocomial (four were catheter related and three occurred postoperatively). Four patients (7%) died: two were severely immunocompromised, one of whom had extensive hemorrhagic varicella; the third had widespread hemorrhage into a large cavernous hemangioma of the skin; the fourth had an initial diagnosis of sudden infant death syndrome. Bacteremia with group A streptococci, although uncommon, continues to cause serious infections in children during the antibiotic era.