The purpose of this study was to determine if pulsed fluoroscopy reduces radiation exposure to pediatric patients undergoing conventional fluoroscopy. Four hundred one consecutive patients were nonrandomly divided into pulsed fluoroscopy and conventional fluoroscopy study groups. Two control groups were also assembled: 474 patients evaluated with conventional fluoroscopy before the study and 138 patients evaluated with pulsed fluoroscopy after the study. We found no difference in fluoroscopy times across the groups. Although the number of digital spot films was slightly higher for the pulsed fluoroscopy study group than for the conventional fluoroscopy study group, we found no difference in the number of digital spot films for the pulsed fluoroscopy study group and for the conventional fluoroscopy control group. Furthermore, the difference in the number of digital spot films was also insignificant for the pulsed fluoroscopy control group and the conventional fluoroscopy study group. The radiation exposure in the pulsed fluoroscopy study group was 50% lower (mean, 0.6 R) than in the conventional fluoroscopy study group. When using pulsed fluoroscopy in the 7.5 pulses-per-second mode, we were able to reduce radiation exposure by 75% of that from conventional fluoroscopy. Pulsed fluoroscopy reduces fluoroscopic radiation exposure to pediatric patients undergoing conventional fluoroscopy. Despite minor image degradation, pulsed fluoroscopy is the technique of choice at our institution.