This article discusses several aspects of pediatric multiple system organ failure (MSOF) including criteria for failure and the frequency of specific organ deterioration. Research of pediatric MSOF is limited and requires further investigation, particularly because the mortality rate is high. In contrast to adults, however, children do have a better outcome. A variety of current state-of-the-art treatment modalities is available for the treatment of organ failure. Related nursing implications are explored because the role of the nurse is important when utilizing these therapies. Stress and grief issues must also be dealt with in order for the family to cope with the severity of this illness.