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Abstract Objective To find the relationship between parental smoking and Carotid Intima Media Thickness (CIMT) measurements. Methodology It was case control study conducted in ultrasound department of DHQ, Dera Ghazi Khan for the duration of 12 months. Sample size was 500 healthy children (250 with history of parental smoking and 250 without) calculated at 90% level of confidence and 80% power of test. The mean ± S.D of IMT of children whose parents does not smoke is 0.63 mm ± 0.08 and 0.65 mm ± 0.08 [21] in children whose both parents smoke. Convenient sampling technique was used. Inclusion criteria: Both male and female healthy children with age group of 10–16 years with and without history of parental smoking were included. Exclusion criteria: Symptomatic and those with exposure to smoking materials other than parental smoking were excluded. Results Children exposed to parental smoking had higher right (0.57 ± 0.05 vs. 0.51 ± 0.05, R = 0.501, P = 0.000) and left carotid IMT (0.56 ± 0.05 vs. 0.51 ± 0.04, R = 0.470, P = 0.000) , indicating a moderate association. Pulsatility index (PI) differences were minimal but statistically significant, with right PI (1.86 ± 0.25 vs. 1.88 ± 0.25, P = 0.000) and left PI (1.77 ± 0.22 vs. 1.81 ± 0.22, P = 0.027) showing slight reductions in exposed children. Resistive index (RI) showed negligible variation, with right RI (0.752 ± 0.02 vs. 0.750 ± 0.03, P = 0.084) being insignificant, while left RI (0.72 ± 0.02 vs. 0.75 ± 0.02, P = 0.023) indicated a small but significant difference. Overall, IMT was more affected by parental smoking than Doppler indices, suggesting greater vascular impact. Conclusion The study found strong links between parental smoking and carotid artery thickness in healthy children. Both parental smoking status and duration correlated positively with artery thickness, indicating risks for cardiovascular health. This underscores the need for interventions to address parental smoking's impact on children's health.