Deep vein thrombosis (DVT) is uncommon in children but can occur given certain circumstances. The authors describe four children in whom DVT developed in association with musculoskeletal sepsis. One child died. Prothrombotic screens were performed on the three surviving children, showing normal hematologic parameters. The severity of DVT complicating musculoskeletal sepsis is emphasized, particularly the potential for septic embolic complications. Deep vein thrombosis should be considered in any child with musculoskeletal sepsis, particularly when a limb is severely swollen or when there are pulmonary septic emboli.