Brachytherapy plays an important role in the organ preservation strategy in vaginal rhabdomyosarcoma (RMS). Here we report our experience and challenges of high dose rate (HDR) intravaginal brachytherapy (IVBT) in a 10-month-old child, a diagnosed case of localized vaginal RMS with a custom-made applicator and immobilization device. The index case is the first pediatric patient, treated with brachytherapy at our institute.