In response to the 2001 U.S. anthrax attack, there has been a proliferation of guidelines for the diagnosis and treatment of patients with anthrax. However, most of these have not specified screening and management protocols for specific populations, such as children. Efforts to prepare for and respond to future attacks of anthrax bioterrorism will be aided by detailed information about the clinical presentation and treatment responses of both adult and pediatric populations exposed to anthrax. A systematic review of case reports of pediatric anthrax were performed to describe the clinical course, treatment responses, and predictors of disease progression and mortality for children with anthrax infection. In addition to cases of inhalational, gastrointestinal, and cutaneous anthrax, we included in our analysis case reports of primary anthrax meningoencephalitis (without an identifiable inhalational, gastrointestinal, or cutaneous source). The data from English-language case reports of children with anthrax addressed three key research questions: 1. What is the evidence for an age-dependent clinical course associated with anthrax? 2. How effective are antibiotic prophylaxis and treatment for anthrax in children compared to adults? Similarly, how effective are other medical treatments in children compared to adults (e.g. ventilator/respiratory support)? 3. Based on the review of evidence for Questions 1 and 2, what are the implications for children versus adults in terms of preparedness and response planning for anthrax exposure (i.e., healthcare provider education on diagnosis and management, considerations for hospitals, vaccination strategies)?