Invasive group A streptococcal infections and STSS have increased as causes of morbidity and mortality among children and adults. In children, respiratory foci appear to be the most common, but skin and soft tissue infection, particularly associated with varicella, also are common. Early diagnosis requires awareness of the presenting features and a high index of suspicion. Antimicrobial therapy that includes clindamycin, therapy with IVIG for those with STSS, and surgical intervention for patients with necrotizing fasciitis may improve outcome. Chemoprophylaxis should be considered among household contacts of patients with severe group A streptococcal disease in high-risk settings. Further studies are ongoing to evaluate the hypothesized link of invasive group A streptococcal infection in children with varicella and NSAID use, to better clarify the pathogenesis of STSS and necrotizing fasciitis, and to better document the risk of secondary spread among close contacts of case patients.