Sixty-five children were evaluated for presence of skeletal inflammatory and ischemic disease with bone scans and roentgenograms. Several characteristic scintigraphic patterns were observed. Bone scans were significantly more sensitive than roentgenograms in early diagnosis of osteomyelitis and its differentiation from cellulitis, septic arthritis, and bone infarction. The child presenting with possible inflammatory bone disease now is benefited by this important refinement in diagnosis. Faced with the difficult dilemma of choosing appropriate therapy in these frustratingly similar problems, the physician can integrate the clinical findings with nuclear imaging to arrive at early appropriate diagnosis and management.