BACKGROUND: The sphericity of the femoral head is a metric used to evaluate hip pathologies and is associated with the development of osteoarthritis and femoral-acetabular impingement. AIM: To analyze the three-dimensional asphericity of the femoral head of asymptomatic pediatric hips. We hypothesized that femoral head asphericity will vary significantly between male and female pediatric hips and increase with age in both sexes. METHODS: Computed tomography scans were obtained on 158 children and adolescents from a single institution in the United States (8-18 years; 50% male) without hip pain. Proximal femoral measurements including the femoral head diameter, femoral head volume, residual volume, asphericity index, and local diameter difference were used to evaluate femoral head sphericity. RESULTS: In both sexes, the residual volume increased by age (P < 0.05). Despite significantly smaller femoral head size in older ages (> 13 years) in females, there were no sex-differences in residual volume and aspherity index. There were no age-related changes in mean diameter difference in both sexes (P = 0.07) with no significant sex-differences across different age groups (P = 0.06). In contrast, there were significant increases in local aspherity (maximum diameter difference) across whole surface of the femoral head and all quadrants except the inferior regions in males (P = 0.03). There were no sex-differences in maximum diameter difference at any regions and age group (P > 0.05). Increased alpha angle was only correlated to increased mean diameter difference across overall surface of the femoral head (P = 0.024). CONCLUSION: There is a substantial localized asphericity in asymptomatic hips which increases with age in. While 2D measured alpha angle can capture overall asphericity of the femoral head, it may not be sensitive enough to represent regional asphericity patterns.