Background <p>Federal regulations require an audible alarm for each passage of 5 min of cumulative x-ray irradiation time during a diagnostic fluoroscopy procedure.&#xa0;In contrast to United States federal requirements, regulations vary amongst individual states.</p> Objective <p>Determine whether a shortened fluoroscopy time alarm reduces pediatric patient ionizing radiation exposure for modified barium swallow studies (MBSS).</p> Materials and methods <p>Fluoroscopy time alarms were changed from the passage of every 5 min to 2 min. A retrospective analysis of MBSS compared patient reference point air kerma and fluoroscopy time before and after the alarm time was shortened.</p> Results <p>A total of 3,875 MBSS performed on patients under the age of 18&#xa0;years were analyzed. Reductions of 14.9% and 19.6% for average and median reference point air kerma (<i>P</i>&lt;0.001) and 15.5% and 16.2% for average and median fluoroscopy time (<i>P</i>&lt;0.001) were observed at the main campus for MBSS performed before and after changing the fluoroscopy time alarm from 5 min to 2 min. Reductions of 14.3% and 9.1% for average and median reference point air kerma (<i>P</i>&lt;0.001) and 13.9% and 8.3% for average and median fluoroscopy time (<i>P</i>&lt;0.001) were observed at the satellite locations for MBSS performed before and after changing the fluoroscopy time alarm.</p> Conclusion <p>This retrospective study suggests a shortened fluoroscopy time alarm can significantly lower pediatric patient dose and fluoroscopy time in MBSS. State and federal regulations should consider establishing flexible fluoroscopic alarm settings, especially when used for the pediatric population.</p> Graphical abstract <p></p>