<p>Intravascular contrast media plays an important role in improving tissue and vascular characterisation in diagnostic imaging and image-guided intervention. Iodinated contrast media are commonly used in imaging modalities which utilise ionising radiation and gadolinium-based contrast agents (GBCA) in magnetic resonance imaging. Intravascular use of iodinated contrast medium is associated with contrast-induced acute kidney injury and GBCA with nephrogenic systemic fibrosis, both of which can lead to potentially significant adverse outcomes in patients with kidney impairment. However, most studies in the literature focus on adults and the evidence in the paediatric population is scarce. In this review, we aim to examine the consensus guidelines and studies in the paediatric population who require intravascular iodinated contrast media and GBCA. At the end, we propose an algorithm to approach the use of intravascular contrast media in children who need to undergo diagnostic imaging or image-guided intervention.</p> Graphical abstract <p></p>