Actinomycosis is a rare soft tissue infection caused by a gram-positive, anaerobic bacteria. It is seen only approximately once a year in major medical centers, and is rarer still in the pediatric population. About 50% of all cases of actinomycosis involve the head and neck. The organism is very difficult to isolate in culture and the differential diagnosis is extensive, prompting one reviewer to name actinomycosis the "masquerader" of the head and neck. We review three cases of actinomycosis over the past ten years (1981-1990) at Texas Children's Hospital, Houston, Texas.