Background <p>This pilot study aimed to compare two transient elastography machines, Fibroscan and Hepatus, with regard to measurements of liver stiffness and steatosis in children.</p> Methods <p>This pilot study compared children and adolescents with and without liver disease undergoing transient elastography using both Fibroscan and Hepatus. Measurements of liver stiffness and steatosis were compared to fibrosis and steatosis stage on liver biopsies when clinically indicated. In healthy children or children with mild liver disease, measurements of liver stiffness and liver steatosis were compared with results from abdominal magnetic resonance imaging and ultrasound, respectively.</p> Results <p>We found a strong positive correlation (<i>r</i> = 0.88) between Fibroscan and Hepatus measurements of liver stiffness. Both Fibroscan and Hepatus had areas under the curve &gt; 0.70 with no differences between machines for no fibrosis vs. mild fibrosis (<i>p</i> = 0.26), mild fibrosis vs. severe fibrosis (<i>p</i> = 0.063), and no fibrosis/fibrosis vs. cirrhosis (<i>p</i> = 0.50). When assessing liver steatosis, measurements ranged from 139 to 319&#xa0;dB/m using Fibroscan and between 144 and 273&#xa0;dB/m using Hepatus. Both machines falsely predicted some fasted children with non-steatotic ultrasound results to have steatosis with no difference between the machines.</p> Conclusions <p>We found Fibroscan and Hepatus to be equal when assessing liver stiffness, indicating that Hepatus can be used on an equal basis as Fibroscan for the assessment of liver stiffness. As for liver steatosis, we found a proportional difference between the machines with a third of measurements outside clinically meaningful limits. Thereby, the use of both machines for the assessment of liver steatosis remains uncertain.</p> Graphical Abstract <p></p>