Rhabdomyolysis is often misdiagnosed and not worked up in children and adolescents with systemic viral illnesses, extreme heat, or who have overexercised.

Complaints of muscle aches are common in pediatrics. In most instances, the aches are transient and benign; occasionally, though, a more significant underlying problem may exist. Rhabdomyolysis is a potentially serious cause of myalgia in childhood and is characterized by the breakdown of striated muscle tissue. Muscle breakdown results in the leakage of muscle cell constituents, including creatine kinase (CK) and myoglobin, into the circulation. Myoglobinuria may result in acute renal failure, the most severe consequence of rhabdomyolysis. Rhabdomyolysis in the pediatric population differs from rhabdomyolysis in the adult population with respect to etiology, clinical presentation, and prognosis.

In children, rhabdomyolysis is frequently the result of viral myositis, trauma, connective tissue disease, and drug overdose. In early childhood, viral infection is the leading cause, accounting for almost 40% of all childhood rhabdomyolysis. Trauma, resulting in muscle compression or muscle injury, is the leading cause of rhabdomyolysis in children older than 9 years of age. Trauma accounts for approximately 26% of all pediatric cases of rhabdomyolysis. Vigorous exercise is well known to occasionally induce rhabdomyolysis in children and adults and accounts for approximately 4% of pediatric cases. In one case report, 119 students developed myalgia and elevation in CK after being instructed to perform 120 pushups in 5 minutes by their gymnastics teacher. Exercise-induced rhabdomyolysis is especially likely if the temperature and humidity are high. Metabolic disorders, such as diabetic ketoacidosis, McArdle disease, and aldolase A deficiency, may additionally result in rhabdomyolysis in the pediatric patient.