Acute hematogenous osteomyelitis (AHO) is the most common musculoskeletal infection in children, primarily caused by hematogenous spread of pathogens—most notably Staphylococcus aureus—to the metaphyseal regions of long bones. Early diagnosis remains challenging due to nonspecific clinical signs, particularly in neonates and younger children, necessitating a high index of suspicion and thorough evaluation. This chapter provides a detailed overview of the etiopathogenesis, clinical features, diagnostic workup—including imaging and laboratory investigations—and management strategies for AHO. Emphasis is placed on the importance of a multidisciplinary approach combining empirical antibiotic therapy with timely surgical intervention, especially in cases involving abscess formation, persistent infection, or complications such as sequestrum or septic arthritis. Adjunctive therapies like calcium sulfate beads, nutritional support, and immobilization are also discussed. Recognizing early signs, such as pseudoparalysis and localized bone pain, and promptly initiating appropriate treatment are crucial to preventing long-term sequelae such as growth disturbances, chronic osteomyelitis, or limb-length discrepancies.