A retrospective analysis of 86 consecutive cases of childhood pneumonia with clinical features indicative of bacterial etiology was performed to delineate the prevalence of and characteristics associated with accompanying bacteremia. All patients had temperature greater than or equal to 40 degrees C, a lobar pulmonary infiltrate on chest radiograph, and a peripheral white blood cell concentration greater than 20,000/mm3 or absolute band count greater than 2,000/mm3. Associated clinical findings included 44% with an "ill" appearance, 37% with respiratory rate greater than or equal to 60/minute, 20% with heart rate greater than or equal to 200/minute, 33% with otitis media. Only one of 86 patients had a bacterial pathogen isolated by blood culture (Haemophilus influenzae, type b). In children older than four months of age with pneumonia whose characteristics are indicative of bacterial etiology, associated clinical findings and laboratory data are insensitive markers for distinguishing those with concomitant bacteremia. The rate of bacteremia in this group of patients is low; if the clinical situation warrants, most with these features do not require empiric hospitalization with parenterally administered antibiotic therapy pending blood culture results.