• We studied 72 children (17 prospectively) with acute buccal cellulitis. The median age was 11 months. Fifty-five percent of patients were bacteremic, and three children without meningeal signs or symptoms had concomitant meningitis. Cellulitis aspirate cultures (eight of 35 positive) and urine bacterial antigen tests (13 of 27 positive) were useful in making an etiologic diagnosis. Infections due to other bacteria were clinically indistinguishable from those due to Haemophilus influenzae type b. The right cheek was affected more often than the left, and only 23 (32%) of 72 patients had otitis media ipsilateral to the involved cheek. The pathogenesis of buccal cellulitis likely involves direct mucous membrane invasion rather than spread from the ipsilateral middle ear.