Echocardiography is particularly important for serial stud- ies in a patient with known or suspected IE. Not only is objec- tive documentation of progressive changes in cardiac function crucial, but identification of other important complications of IE by echocardiography can have direct bearing on decision making with regard to early surgical intervention, which can be critical for successful outcome.102 The limited capacity of TTE to detect complications of IE in adults,103 particularly in those with prosthetic valves, has been confirmed. Although TTE has been shown to effectively detect endocarditis in young children (up to 97% sensitivity), for those >10 years of age and weighing >60 kg, the TEE, as in adults, has been shown to be a more sensitive tool.104 Although there is limited experience with TTE for detect- ing aortic root abscesses, which can complicate native or prosthetic aortic valve IE in pediatric patients, it can be use- ful to perform TEE in patients who are at high risk for this complication. Recommendations 1. TEE is recommended for infants and children who had chest wall disruptions from previous surgery or from trauma or who have congenital anomalies involv- ing the thoracic cage (Class I; Level of Evidence B). 2. It can be useful to perform TEE in pediatric patients who are at high risk for aortic root abscesses, which can complicate native or prosthetic aortic valve IE (Class IIa; Level of Evidence C). Antimicrobial Treatment The principles of treatment of pediatric endocarditis are simi- lar to those for treatment of adult endocarditis.2 In patients who are not severely ill and whose blood cultures are still negative, or whose cultures may be positive for organisms that are frequently contaminants, it is reasonable to withhold antibiotic drugs for 48 hours while additional blood cultures are obtained. 