Lyme disease, caused by a tick-transmitted spirochete, has significant musculoskeletal manifestations in children as well as in adults. A series of 23 children with Lyme disease is examined. Acute arthritis was present in five cases, with the knee being involved in three of these cases. Twelve cases (52%) presented with arthralgias, and 10 cases (43%) presented with myalgias. Neurological manifestations were present in 39% of the cases. Five cases have demonstrated recurrent polyarthralgias. Lyme disease should be considered in the differential diagnosis of arthralgias and arthritis in children.