Diagnosing tuberculosis (TB) in children and adolescents pose a diagnostic challenge due to sparse symptoms and clinical signs. Children are at a much higher risk than adults of progression to severe disease. In this review, the presentation and management of childhood TB is described. TB in children indicates ongoing transmission and is an indicator of failing disease control in the community. Tests suited to predict progression are warranted, and targeting latent infection is essential to achieve TB elimination. We recommend a low threshold for referral of children suspected of active or latent TB.