Objective: To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. Methods: Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. Results: Modern MDCT systems are available in 77% of the facilities surveyed with dedicated paediatric CT protocols available in 94%. However, protocols for some age groups were unavailable in around 50% of the facilities surveyed. Indication-based protocols were used in 57% of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDIvol values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49% of sites. Conclusion: There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA. Key Points: • Paediatric computed tomography (CT) practice was audited in 40 less resourced countries. • This audit revealed widespread (up to 100 times) variation in radiation dose. • Specific CT protocols for certain age groups were frequently (ca. 50%) unavailable. • This survey demonstrates significant potential for improvement in paediatric CT practice. • Multinational networking is an effective mechanism for quality improvement. © European Society of Radiology 2012.