The rapid increase in the number of computed tomography (CT) scans performed has augmented concerns about safety risks. Although some of this increase is certainly legitimate and improves patient care, there is certainly still a need for dose reduction. Patients may insist on receiving a CT scan, and defensive medicine can certainly be a source of useless exposure. This means that the principle of justifying CT examinations needs to be reemphasized. Dealing with a properly justified examination is then a matter of image optimization aimed at providing the necessary diagnostic information at the lowest possible applied dose. The optimization of CT acquisition protocols involves teamwork in which manufacturers, legal bodies, radiologists, technologists, and medical physicists all play an important role. The purpose of this article is to review the latest progress in terms of the optimization of CT acquisition protocols in the pediatric population.