Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited available evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP in children and adolescents and their associations with female gender, age and instrument exposure. The study surveyed 731 children learning musical instruments (460 females) ranging in age from 7-17 years. Lifetime symptoms, monthly symptoms and monthly disorders (the inability to play an instrument as usual) were examined. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalences. A total of 67% students reported PRM symptoms at some point, 56% reported PRM symptoms within the last month and 30% reported an inability to play as usual within the last month. Female gender was significantly associated with PRMP (OR 1.38-1.56, p = 0.004-0.046), as was age (OR 1.19-0.23, p less than 0.001). After adjustment for gender and age, type of instrument (upper and lower strings, woodwind and brass) were significantly associated with all PRMP (p less than 0.005) and playing three instruments was protective against monthly symptoms (OR 0.43, p = 0.05). The study concludes that the high prevalence and disabling impact of playing-related musculoskeletal problems is clearly an important issue for child and adolescent health with gender, age and instrument exposure important factors for risk management. (Contains 4 tables and 2 figures.)