Background: Developmental delays in children may result from a variety of neurological adverse effects on the developing brain. One of the most important methods for assessing children with developmental delay is neuroimaging, specifically magnetic resonance imaging (MRI) of the brain, which provides useful information about brain tissue structure and abnormalities. In this study, we aim to evaluate the utility of MRS in the diagnostic evaluation of children with developmental delays who have normal brain structures. Methods: This is a retrospective study done at King Abdulaziz University Hospitals. We included 70 patients who have undergone structural MRI brain and spectroscopy done in the same setting, their ages ranged from 3 days to 21 years. MR spectroscopy was performed in all patients by using a single voxel point-resolved spectroscopy (PRESS) Results: A total of Seventy patients were studied from 2015 – 2024. The results indicate that all patients who had normal structural MRI also had normal spectroscopy findings. However, of the 11 participants who had MRIs suggestive of metabolic pathology, only 2 children (15.40%) showed no evidence of metabolic disease on subsequent spectroscopy imaging. Conclusions: We suggest performing MRI/1HMRS only if there is an MRI brain structural abnormality. Otherwise performing MRI spectroscopy in patients with normal structural MRI has no added value.