The purpose of this study was to evaluate the diagnostic quality of digital tomosynthesis (DT) images for pediatric imaging of the spine. We performed a phantom image rating study to assess the visibility of anatomical spinal structures in DT images relative to digital radiography (DR) and computed tomography (CT). We collected DT and DR images of the cervical, thoracic and lumbar spine using anthropomorphic phantoms. Four pediatric radiologists and two residents rated the visibility of structures on the DT image sets compared to DR using a four point scale (0 = not visible; 1 = visible; 2 = superior to DR; 3 = excellent, CT unnecessary). In general, the structures in the spine received ratings between 1 and 3 (cervical), or 2 and 3 (thoracic, lumbar), with a few mixed scores for structures that are usually difficult to see on diagnostic images, such as vertebrae near the cervical-thoracic joint and the apophyseal joints of the lumbar spine. The DT image sets allow most critical structures to be visualized as well or better than DR. When DR imaging is inconclusive, DT is a valuable tool to consider before sending a pediatric patient for a higher-dose CT exam.