Sickle beta + thalassemia (Sβ+) is considered to be a mild form of sickle cell disease (SCD). However, some patients with mild disease can present with osteonecrosis. Here, we present a three-year-old male who presented with acute pain and baseline hemoglobin of 13 g/dL with multifocal osteonecrosis of multiple areas in his vertebrae, pelvis and femurs that improved with partial exchange transfusion and hydroxyurea.