BACKGROUND: Among children and adolescents, up to 40% will experience musculoskeletal pain (MP), which can significantly impair functional ability, reduce quality of life, cause emotional distress, and lead to sleeping disorders for both patients and their families. The first-line treatment often involves pharmacological interventions, even though there is a lack of evidence supporting the efficacy or the safety of this approach in this specific age group. Recent guidelines recommend the implementation of preventative strategies and physical tools as the first option to minimize the use of medications. We aimed to provide an expert opinion on the use of heat therapy for MP management in young patients. METHODS: This paper is the result of a virtual advisory board held by the authors in order to discuss and provide an expert opinion about the use of heat therapy in MP in children and adolescents. RESULTS: MP is a significant burden affecting children and adolescents. While non-steroidal anti-inflammatory drugs are currently the first-choice treatment of acute and chronic MP in children and adolescents, avoiding or reducing them in such patients is advisable, to reduce side effects and to prevent the development of chronic pain and medication overuse headaches. Heat therapy can be an additional treatment option due to its ability to promote muscle relaxation, enhance blood circulation, and modulate nociceptors with a good safety profile. CONCLUSIONS: MP in children and adolescents is a common condition that should be approached multidisciplinary, including information, therapeutic exercise and physical therapies like hot or cold therapies. Future studies should be conducted to evaluate the safety, efficacy and indications of each treatment in MP.