<p>Children are not just small adults. This is particularly true when designing optimal MRI examination approaches for paediatric patients ranging from neonates to tall 17-year-olds. We highlight many of the latest technological advances that are starting to make a difference in paediatric MRI, as well as some newer technologies from research that can be extremely useful in clinical practice when imaging children and babies. Delivering high-quality paediatric MRI requires not only technical expertise and appropriate selection of timings, MRI sequences, age-specific motion-restraining pads, motion-tracking methods, coils and audio-visual devices. It also requires a holistic, person-centred approach that recognises the unique needs, anxieties and vulnerabilities of child-patients, as well as their families or carers. Effective preparation, appropriate environmental design and play-based support all have a pivotal role in enabling more children to undergo MRI without the need for sedation or general anaesthesia. This not only reduces clinical risks and service pressures but also enhances the child’s experience and long-term engagement with healthcare. Sedation and general anaesthesia remain essential tools for selected patients, but their use should be guided by robust risk/benefit assessment, informed consent and adherence to national guidelines.</p> Graphical abstract <p></p>