When imaging a small patient, the priority is to keep radiation exposure as low as possible while still producing a diagnostically useful image. The factors mA and exposure time together determine the total amount of X-ray photons produced, known as mAs. Lowering either mA or the exposure time reduces the dose, and using the smallest mAs that still yields an acceptable image is how clinicians apply the ALARA principle in pediatrics. Guidelines and the manufacturer’s technique charts exist precisely to guide these reductions for different patient sizes, ensuring you stay within safe, validated ranges while maintaining image quality. Increasing mA or extending exposure time would raise the patient’s radiation dose, which is especially undesirable for small patients. Adjusting kVp is part of optimization, but it should be done within the recommended pediatric ranges to avoid compromising image contrast; the strongest, most reliable dose-reduction move in this scenario is to reduce mA and time according to official guidelines and manufacturer recommendations.