The main clinical manifestations of neuromuscular disease are muscle weakness, muscle atrophy, and poor motor tolerance or myalgia or sensory abnormalities. Ultimately, this leads to motor (sensory) impairment. The neuromuscular diseases are broadly divided into: (1) diseases caused by primary skeletal muscle (muscle) abnormalities, including myotonic dystrophy (there are dozens of types of myotonic dystrophy), congenital myopathies (there are dozens of myopathies) and secondary skeletal muscle diseases, including inflammatory myopathies (several types), metabolic myopathies (several types), endocrine myopathies (several types), mitochondrial myopathies, toxic myopathies, etc. (2) Neurogenic myopathies and peripheral neuropathies (not to dozens of species). (3) Diseases of the nerve-muscle junction. Muscle biopsy, mainly suitable for primary (congenital myopathies, etc.) or secondary to myopathies caused by skeletal muscle (metabolic myopathies, inflammatory myopathies, etc.). In some of these myopathies, muscle biopsy does not need to be performed and the diagnosis can be confirmed by clinical manifestations combined with genetic diagnosis. However, most myopathies require a muscle biopsy. Through muscle biopsy, the physician can clarify the skeletal muscle pathological changes and determine whether the skeletal muscle changes in the child are myotonic-like pathological changes or inflammatory pathological changes, etc. Histochemical and enzyme chemical examination of skeletal muscle or special staining can also be used to find increased fat droplets or characteristic changes such as central axial pores, micro axial pores, rods, RRF, etc. to infer which type of disease the child belongs to or to make a diagnosis or differential diagnosis by immunohistochemical staining or immunoblotting to identify the missing protein. However, in many cases, muscle biopsy only provides some characteristic pathological information that is not specific (limitations of muscle biopsy). The experienced specialist uses these characteristic changes, combined with the analysis of the specific clinical presentation of the child, to purposefully detect the relevant genes (genetic examination of muscle biopsy are two different tests, and muscle biopsy often provides important clues to the relevant genetic examination or the analysis of genetic findings provides an important pathological basis). The diagnosis of neurogenic myopathy, peripheral neuropathy, and neuromuscular junction disease does not require a muscle biopsy. A nerve biopsy has the potential to aid in the diagnosis. Therefore, blindly performing a muscle biopsy can only cause unnecessary pain to the patient. about 80% of pediatric neuromuscular disorders, are hereditary. There are several types of hereditary disorders. Hereditary disorders do not necessarily see similar patients in the immediate family. Genetic heterogeneity and clinical heterogeneity create a lot of confusion for clinicians in diagnosis and treatment. Proper understanding of the need for muscle biopsy, indications, and communication with a neuromuscular disease specialist is beneficial to the patient and to the physician. One should not think: all neuromuscular diseases need muscle biopsy, muscle biopsy will definitely confirm the diagnosis after muscle biopsy, or muscle biopsy replaces genetic testing, etc. In the past 2-3 years, we have vigorously carried out non-invasive skeletal muscle MRI to assist in the diagnosis of neuromuscular diseases, and have achieved more satisfactory results.