Objective Digital images might contribute to stigma associated with mental disorders. The aim of this study was to investigate whether these images accurately represent pediatric mental disorders, as well as to explore specific image-related factors that influence perception. Methods Four hundred pictures were retrieved from three stock photograph websites (‘Shutterstock’, ‘iStock’ and ‘Adobe’) and ‘Google Images’ for mental disorders (ADHD, ASD, and depression) and somatic diseases (asthma, diabetes, and influenza) in childhood. Each picture was scored for gender, age, and emotional load. Data was compared against data from epidemiological studies. Ordinal regression was used to predict emotional load from image-related factors. Results There was a significant difference in gender representation of ADHD, ASD, depression, diabetes, and influenza. With respect to age, models were significantly younger in pictures of depression but older in pictures of influenza. Pictures of ASD, asthma and diabetes were mostly positive; however, images for ADHD, depression and influenza carried more negative connotations. For mental disorders, a more positive emotional load was associated with images of young and/or male models. iStock gave more positive images. Conclusions Digital images available in stock databases do not accurately represent pediatric mental and somatic disease. For mental disorders, image-related factors (including age, gender and emotional load) may influence societal perception.