CA-MRSA isolates are increasingly common pathogens in children with acute, hematogenously acquired osteomyelitis and clinicians have to consider this pathogen in the selection of initial empiric treatment. With the emergence of pvl+ CA-MRSA isolates, unusual manifestations of acute osteomyelitis have become common including venous thromboses and multiple sites of infection. MRI is currently the imaging modality of choice for osteomyelitis. Drainage of purulent collections is also more common in association with the pvl+ strains. The role of newer antibiotics such as linezolid and daptomycin for the treatment of CA-MRSA musculoskeletal infections in children needs further study.