The American Academy of Pediatrics (AAP) released recommendations on dealing with biological terrorism in February 2020, emphasizing the historical use of bioterrorism agents like Salmonella, anthrax, and botulinum. This chapter is an updated summary for hospitals and first responders. Bioterrorism involves intentionally using biological agents to cause harm for political motives. Category A agents, such as anthrax and smallpox, pose significant public health threats due to their high morbidity and mortality rates. Recognizing bioterrorist attacks can be challenging, but clues like unusual disease patterns, unexplained deaths, and atypical age groups can indicate a potential attack. Health care providers must remain vigilant and report any suspicious cases promptly to authorities to ensure a rapid and effective response.