Necrotizing fasciitis (NF) is a rare, rapidly progressive bacterial soft tissue infection with a high risk for morbidity and mortality. Although more common in adults, NF also affects the pediatric population. Many bacterial organisms can cause NF, but group A Streptococcus is the most common monomicrobial cause of disease. Necrotizing fasciitis remains principally a clinical diagnosis, and it is often missed early in its presentation because of the difficulty in differentiating it from more common soft tissue infections. The criterion standard for diagnosis and the mainstay of therapy are surgical debridement. Time to initiation and completion of therapy remains the most important factor in patient outcome, highlighting the importance of early recognition and intervention in this potentially devastating disease.