Aims: This study evaluated the diagnostic quality of bitewing radiographs and children's acceptance between the Snap-A-Ray^® Xtra film holder and the novel bitewing clear contact (BCC) child film holder. Material and methods: A total of 120 bitewing radiographs were taken on the school-age participants within 6 months. At the initial visit, each participant was randomly assigned to have one side of their mouth imaged using the Snap-A-Ray® Xtra device, while the other used the BCC child film holder. After 6 months, the device used for each side was reversed. The diagnostic quality of the radiographs was assessed based on the degree of interproximal overlapping of adjacent teeth. The patients’ acceptance scores were recorded using the three schematic faces scale. The diagnostic quality was compared using sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. The Wilcoxon signed-rank test compared the children's acceptance. Results: Sensitivity and specificity values were 46.2 and 86.7% for the Snap-A-Ray® Xtra and 47.05 and 86.27% for BCC child film holders, respectively. The areas under the ROC curve for the Snap-A-Ray® Xtra were 0.695 [95% confidence interval (CI), 0.60–0.78] and 0.685 (95% CI, 0.59–0.77) for the BCC child film holder. Moreover, patients’ acceptance of the two film holders was similar (p = 0.218). Conclusion: There was no significant difference in radiographic diagnostic quality and patient acceptance between the two film holders. Therefore, the BCC child film holder can be used as an alternative bitewing film holder. Clinical significance: The BCC child film holder can be considered a viable alternative to conventional bitewing holders for pediatric dental radiography. Its design characteristics enable the acquisition of accurate radiographic images while potentially minimizing patient discomfort and anxiety during the procedure, which can be particularly beneficial when working with children.