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Infections with toxin-producing strains of streptococcus pyogenes or staphylococcus aureus in children are acute emergencies. Fatality can be reduced through rapid diagnosis and immediate action by treating physicians. Knowledge regarding toxic shock syndromes (TSS) should be basic armamentariurn for pediatricians. Most TSS patients require intensive care treatment. The involved toxin acts as a superantigen. Through the extensive release of mediators (»cytokine storm«), the body's immune system reacts quickly with broad and unspecific activation response. Organ damage occurs as result of a systemic drop in blood pressure, based on an increased capillary permeability. Initially, the patient might present with fever and scarlatinous rash. Thus, TSS should be suspected in children with the above clinical signs, particularly in the absence of tonsillitis. Other clinical manifestations can be low blood pressure, hyperemia of the mucous membranes and specific signs and symptoms depending on affected organs. Examples are myalgia, vomitus, diarrhea, oliguria, dyspnea, headache and impaired consciousness. Differential diagnosis is broad, making early detection due to non-specific signs and symptoms often difficult. An indicative clue would be the presence of mucosal or skin injury (atopic dermatitis, varicella, soft tissue infections, postinterventional, pharyngitis) as well as specific pathological laboratory parameters. The diagnosis follows with reference to a clinical case definition. In addition to rapid and extensive fluid replacement, treatment is based on a staphylococcal betalactam-antibiotic as well as the administration of a bacterial translation inhibitor. With a high regional proportion of Methicillin-resistant staphylococcus aureus (MRSA), betalactam-antibiotic should be replaced by vancomycin. In individual cases, additional therapy with immunoglobulins should be considered.