Forty-two cases of salicylate intoxication in infants and children observed over a 10-year-period are reviewed. The majority of the 13 cases of poisoning due to accidental ingestion occurred in the 2- to 4-year age range whereas the 29 intoxications resulting from therapeutic administration of salicylates occurred chiefly in infants. Accumulative therapy intoxication is more likely to occur in infants rather than older children not only because of an unawareness of the dangers and of the proper dose of acetylsalicylic acid, but also because of the decreased renal excretion of salicylates due to renal immaturity, and pre-renal azotemia due to dehydration resulting from the disease for which the drug is given. The marked variability in time response of an individual to salicylates is emphasized. Even in poisoning resulting from accidental ingestion, where the effects of an underlying disease do not have to be considered, the plasma concentration of salicylate, clinical response, degree of toxicity at a given concentration of salicylate, and time required for renal excretion varied greatly for children of time same age and size who ingested comparable amounts of salicylate. Severe intoxication at how concentrations of salicylate in the plasma was observed. Hyperventilation and vomiting are the most common clinical manifestations of salicylism but a hemorrhagic diathesis due to hypoprothrombinemia, hyperpyrexia, delirium or coma, circulatory collapse, and respiratory failure may be observed. The unique effect of salicylates on acid-base balance with an initial respiratory alkalosis progressing to a metabolic acidosis is discussed. A treatment program based on physiologic principles is outlined. The important role of drug ingestion, especially acetylsalicylic acid, as a cause of death is re-emphasized and a plea is made for better education and attention to the potential dangers of salicylates.