Hey there, fellow rad tech! If you’ve ever tried to get a perfect PA chest on a screaming two-year-old at 2 a.m., you already know: kids are not just tiny adults. Pediatric imaging can feel like the ultimate test of your skills, patience, and creativity — all at the same time.
I’ve been in the trenches for years, and I still learn something new on almost every peds shift. So I put together this super-practical, no-fluff guide (updated for 2025) to help you nail pediatric X-ray, CT, MRI, and ultrasound while keeping radiation dose tiny and anxiety even tinier.
Let’s dive in — grab your coffee and let’s make you a pediatric imaging rockstar.
Why Kids Make Us Sweat (and Why You Need Special Skills)
Kids are basically aliens in tiny sneakers. Here’s why you can’t just shrink your adult protocols:
- Their heads are huge compared to their bodies (hello, giant thymus on every chest X-ray).
- Their cells are dividing like crazy → way more sensitive to radiation.
- They have zero chill when it comes to holding still.
- Most of them think the X-ray tube is a monster that eats kids.
Bottom line? You have to adjust your technique, your positioning, and your entire vibe when a child rolls into your department.
Radiation Safety: ALARA Isn’t Optional with Kids
We all know ALARA (As Low As Reasonably Achievable), but with pediatric patients it’s basically the 11th commandment.
Here’s what actually moves the needle in 2025:
- Drop that mAs like it’s hot and bump kVp a little if contrast allows.
- Collimate like your license depends on it (because it kind of does.
- Take the grid OUT for anyone under ~10–12 cm thick (most babies and toddlers). You’ll cut dose in half with almost zero image quality loss on modern DR plates.
- Use PA chest and spine whenever the kid can tolerate it — breast and thyroid dose drops 80–90%.
- Shielding update: most new guidelines say skip routine gonadal shields if you’re collimating correctly (they cause more repeats than protection these days).
Biggest sins I still see in 2025?
- Using the exact same adult exposure chart
- Leaving the grid in for a 5 kg baby
- Doing every chest AP “because it’s faster”
- Repeating exams because of motion instead of fixing the motion first
How to Talk to Kids So They Actually Listen (and Stay Still)
Forget “big stick energy.” With kids, you need “Disney cast member + ninja” energy.
Quick age-by-age cheat sheet:
Babies (0–6 months) Swaddle, warm room (78–82 °F), feed right before the exam, and pray to the sleep gods. Works like magic for MRI and ultrasound too.
Toddlers (1–3 years) Slow voice, bubbles, ceiling projectors, tablets, or a parent doing the “mommy hug” hold. Never underestimate the power of singing “Baby Shark” in perfect pitch.
Preschool & school-age (4–10) Give them control: “Do you want to push the button or should I?” Show them a demo picture. Kids love being the expert: “You’re going to be my helper superhero.”
Teens Talk to them like humans. Explain the “why” (radiation risk, how long the scan takes, etc.). Respect privacy. Knock. Don’t call them “sweetie.”
Pro parent hack: Give mom or dad a job (“Your only mission is to hold this exact spot — you’ve got this”). Parents love having a purpose, and it keeps them from hovering.
Positioning Hacks That Save Your Back (and Their Dose)
X-ray Quick Wins
- Pigg-O-Stat is awesome… until the kid loses it. Always have a Plan B (parent hug or supine with sandbags).
- Chest on infants? Expose on second breath, not full inspiration (thymus looks better).
- Always include the diaphragm on upright abdomens — doctors hate cropped gas patterns.
- Extremity trauma? Image both sides. Peds docs live for symmetry.
CT Like a Pro
- Single phase only unless the radiologist begs.
- 70–80 kVp + iterative/AI reconstruction = gorgeous images at half the dose.
- Most kids over 6 months can do a head or chest CT awake if you have a child-life specialist or a good distraction system.
MRI Survival Guide
- Under 6 months → feed-and-sleep + ear plugs + vacuum pillow = 90% success rate.
- 4 years and up → MRI video goggles are literal lifesavers.
- Use Propeller/BLADE sequences for the wiggle worms.
Ultrasound Love
- Warm gel. Seriously. Cold gel = instant screaming.
- High-frequency linear probe for everything superficial.
- Let the kid watch the screen — “Look, that’s your baby brother/sister’s heartbeat!” works on siblings too.
The Really Tough Days (Trauma, Autism, Oncology, Abuse Cases)
- Trauma: ABCs first, perfect images second. Log-roll, portable, parent present when safe.
- Autism/sensory issues: Visual schedules, noise-canceling headphones, dim lights, practice run on a fake machine if possible.
- Oncology kids: Track cumulative dose like a hawk. Push for US or MRI first.
- Suspected non-accidental trauma: Follow your hospital’s exact skeletal survey protocol. Stay neutral, document everything, report properly.
Keep Getting Better (Because Guidelines Change Every Year)
The tech, the dose recommendations, the immobilization gadgets — everything evolves fast.
If you want structured, ASRT-approved credits that actually teach useful stuff, check out Gage CE’s 2025 pediatric lineup. Real talk: their “Zero-Sedation MRI” course and the 8-hour radiation protection masterclass changed how I practice.
Final Thought From One Tech to Another
At the end of a crazy shift, when you finally get that perfect chest X-ray on a terrified three-year-old who’s now waving goodbye and saying “thank you,” that feeling? That’s why we do this.
You’re not just taking pictures. You’re protecting tiny humans, calming scared parents, and giving doctors the answers they need — all while juggling bubbles, swaddles, and a lead apron that never fits right.
Keep lowering those doses. Keep practicing your toddler voice. Keep learning.
You’ve got this.