The child with acute myelogenous leukemia (AML) is at high risk for infection, especially during the induction phase of therapy. Appreciation of special risk factors and the changing spectrum of infecting pathogens is critical to development of the most appropriate initial evaluation and therapy for these children. Based on the available data in pediatrics, and extrapolation from studies in adult populations, we make recommendations for the initial empiric management of the febrile child with AML, the proper use of vancomycin, and management of special infectious complications related to central venous catheter use. Fungal infections are rapidly becoming the single most serious supportive care problem for children with AML. Optimal initial empiric therapy, treatment of proven systemic infections, and current status of attempts at prophylaxis are reviewed. Finally, the issue of colony stimulating factor use in AML is broached. Hopefully, studies underway will demonstrate the benefits and risks of these agents in AML. The time is long past due for large, well designed studies of supportive care in AML. Therapeutic trials addressing this very important aspect of the total care of the child with AML need to accompany the advancing new anti-oncologic therapies of the disease.