COVID-19 clinical manifestations and radiological findings are milder and less specific in children.• The presence of fever, and fever duration are clinical findings associated with pathological chest imaging.• The most common pattern seen in pathological chest X ray were bilateral diffuse interstitial pattern followed by perihilar bronchial wall thickening.• Consensual specific age-adjusted protocols regarding chest imaging indications in pediatric COVID-19, as the one developed, are needed.• Imaging should not be used as a screening tool or a routine complementary test in pediatric hospitalized patients with COVID-19.