A shortage of paediatric staff could see children in the north-east travelling hundreds of miles for routine surgery.
Some young patients have waited close to a year-and-a-half for procedures as NHS Grampian has struggled with staffing levels.
Now bosses are trying to secure operations elsewhere in Scotland or the UK in an effort to prevent waiting times dragging on.
Among those waiting the longest periods for treatment are children in need of routine plastic surgery procedures.
Of those who underwent treatment at the Royal Aberdeen Children’s Hospital in February and March this year, 90 per cent had waited 76 weeks or more for their operation.
This is the highest waiting time for anyone in the health board area.
A spokeswoman for NHS Grampian said: “We routinely refer children to other centres in Scotland and elsewhere in the UK for specialist treatments that are not available within NHS Grampian.
“In addition, we are at the early stages of exploring whether it would be possible for some patients who are currently waiting longer than we would wish for their treatment within Grampian to receive an earlier operation at other locations within Scotland or potentially further afield.
“These would predominately be patients awaiting plastic surgery operations.
“Any such referrals outwith Grampian would be through agreement with the families and carers of the children.
“All patients would retain the right to wait for the treatment to be provided in Grampian if they so preferred.”
NHS Grampian has 25 consultant paediatricians. At present, ten percent of all children’s doctor posts are unfilled – about double the Scottish average.