<p>Non-contrast transperineal ultrasound is a valuable, non-invasive, and cost-effective imaging modality, particularly advantageous in pediatric populations. This painless procedure has a robust safety profile due to the absence of ionizing radiation, the lack of need for specialized equipment, and the avoidance of sedation. It can be performed as either an isolated examination or an adjunct to transabdominal ultrasound. Despite these benefits, its clinical application remains underutilized and unfamiliar to many practitioners. This technique plays a crucial role in the diagnosis of various pediatric conditions, including anorectal and genitourinary malformations (e.g., ectopic ureter, posterior urethral valves, Müllerian anomalies, and disorders of sex development), neoplastic processes affecting the genitourinary and anorectal systems (e.g., labial, vaginal, and urethral tumors), and perianal inflammatory diseases. This article provides a concise review of the embryological development of the genitourinary and anorectal systems, a description of normal male and female pelvic anatomy visualized via transperineal ultrasound, and an overview of the primary indications and associated findings of this technique in children.</p>