BACKGROUND: Early childhood radiation exposure carries an enhanced radiation risk of about two to three times as high as in adults. The objective of this study was to determine local diagnostic reference levels for the most frequent pediatric x-ray examinations in Addis Ababa, Ethiopia.METHODS: A cross-sectional study was conducted on 18 public and private hospitals/clinics in Addis Ababa. A total of 864 pediatric patients, undergoing eight types of routine x-ray examinations with 13 projections were evaluated from December 18/2017 to March 17 /2018. All pediatrics were categorized under four age groups. Anthropometric and radiographic parameters of each patient were recorded .The minimum, maximum, mean and third quartile values of entrance surface dose were analyzed using SPSS version 23. Finally, the suggested local diagnostic reference levels were compared with national and international reference dose values.RESULTS: Of the 864 pediatric patients, chest (AP/PA), lower and upper extremity (AP/PA) accounted for 501(58%), 110 (13%) and 103 (12%) respectively, accounting to 714(83%) of the total pediatric x-ray examinations. The suggested local diagnostic reference levels  of  chest X-ray (AP/PA) examinations in mGy were: (0.09,0.13,0.17,0.17) for age group (0-<1,1-<5 ,5-<10, and 10-<15), respectively. Similarly, for same  age group (0-<1,1-<5 ,5-<10, and 10-<15)  the  suggested local diagnostic reference levels  of  lower and upper extremities  in mGy were:  (0.06,0.08,0.09,0.09) and (0.04,0.05,0.05,0.06), respectively. CONCLUSION: The suggested local diagnostic reference levels   were slightly higher than the national and international guidance levels, indicating the need for establishment of diagnostic reference levels in the country.KEYWORDS: X-ray, entrance surface dose, local diagnostic reference levels, Dose Optimization