About 40 million MRI studies are performed annually in the USA, with an estimated ten million of these studies conducted on pediatric patients (Anzai et al., J Magn Reson Imaging 49:e40–e48, 2019). Between 2000 and 2016, pediatric MRI utilization increased by 133% (Smith-Bindman et al., JAMA 322:843–856, 2019). MRI has been a valuable tool in many areas of pediatric orthopedics; however, the role of MRI in some cases remains controversial. The current chapter explores some of the most common scenarios in pediatric orthopedics where MRI is employed. The central question addressed is: In which instances do MRI studies clearly enhance patient care, and where do they provide limited or little value? This chapter will not discuss MRI utilization in pediatric trauma or orthopedic oncology.