Although sepsis is the primary cause of pediatric death globally, it has only been recognized as distinct from adult sepsis recently. Accordingly, care for pediatric sepsis has just been the adaptation of adult diagnosis and treatment to fit the pediatric patient. However, due to the physiological differences between children and adults, it is now evident that pediatric sepsis is an entity distinct from adult sepsis. This article describes the challenges community hospital emergency providers face with diagnosing pediatric sepsis and septic shock in the ED.