: Introduction: Abdominal pathologies in children encompass a wide spectrum of conditions, ranging from congenital anomalies to acquired diseases. Early and accurate diagnosis is crucial for effective management and improved outcomes. Ultrasonography (USG) has emerged as a preferred imaging modality in pediatric patients due to its non- invasive nature, absence of ionizing radiation, and ability to provide real-time imaging. Unlike computed tomography (CT) and magnetic resonance imaging (MRI), USG is widely available, cost-effective, and well-tolerated by children. Material and Methods This prospective observational study was conducted over a period of 18 months at a tertiary care pediatric hospital. The study protocol was approved by the institutional ethics committee, and informed consent was obtained from the parents or guardians of all participants. A total of 90 pediatric patients (aged 0–18 years) presenting with abdominal pain, distension, vomiting, or other abdominal symptoms were included in the study. Patients with a history of recent abdominal surgery or those requiring emergency intervention without imaging were excluded. Results: Nearly 40% of cases had normal USG findings, indicating no visible pathology in those patients. The most commonly detected pathology was intestinal (20%), followed by hepatobiliary (16.7%) and renal (13.3%) abnormalities. Other findings (11.1%) were less frequent but still significant. Sensitivity is 86.7%, meaning USG correctly identified 86.7% of actual cases. Specificity is 95.5%, indicating a low rate of false positives. Sensitivity is 83.3%, which is slightly lower, but specificity is 96.3%, suggesting a strong ability to rule out false positives. The highest sensitivity at 88.9%, meaning USG is very effective at detecting these conditions, and specificity is 94.7%. Conclusion Ultrasonography is a highly effective and safe imaging modality for diagnosing pediatric abdominal pathologies. Its high diagnostic accuracy, coupled with the absence of radiation exposure, makes it an indispensable tool in pediatric radiology.