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INTRODUCTION: Despite the possible harms of ionising radiation, guidelines for the use of X-rays in children are not available locally. International guidelines are also limited., AIM: The aim of this study was to evaluate all X-rays taken in paediatric patients in Primary HealthCare in Malta over a period of six months., METHOD: A list of all X-rays taken in children aged 0-16 years during the period of July 2020 till December 2020 in all publicly funded Primary HealthCare health centres in Malta was compiled using the Radiology Information System (RIS), Picture Archiving and Communication System (PACS) and iSOFT Clinical Manager (iCM). A form was designed using Microsoft Excel® to facilitate collection of data. Patient demographics were collected, and data was evaluated for the type of X-ray ordered, reason for request and source of referral, as well as the result of the X-rays and any subsequent follow-up organised., RESULTS: Over the six-month period studied, 1176 children were referred for X-ray imaging with 1324 X-rays being taken. These were mostly 13-16 years of age, with the majority being male. Most patients were referred by general practitioners working in health centres, with X-rays of the upper limb being the most ordered radiographs. The commonest reason for requesting an X-ray was a history of trauma. In total, 75.8% of X-rays ordered were reported as normal. Only 4.3% of all requests referred to existing guidelines. With reference to lower limb X-rays, Ottawa rules were referred to in 11.4% of X-ray requests, with 78.6% of these being reported as normal. Follow-up visits were planned for 34% of children referred for X-ray., CONCLUSION: The results of this evaluation show that most X-rays in the paediatric population were taken in view of trauma, and approximately 75% of all X-rays taken were normal. Educating doctors about the use of judicial x-ray imaging and development of local guidelines might help to reduce unnecessary investigations., peer-reviewed