The incidence of tuberculosis (TB) is decreasing on a global level, though in Africa south of the Sahara it is on the increase, a result of the fatal combination of HIV and TB. The burden of childhood TB is not exactly known, but according to estimates of the World Health Organization (WHO), about 1 million children <15 years are living with the disease globally. This paper looks into some of the challenges of childhood TB in Sub-Saharan Africa, through studies of selected articles on the topic, focusing on three main issues: The advantages and disadvantages of BCG vaccination, the problem of diagnostics in a low income area, and the special awareness necessary when treating children with TB/HIV coinfection. Studies show that BCG vaccination given to infants in highly endemic areas is beneficial when it comes to preventing miliary TB and tuberculous meningitis, but the vaccine also may cause disseminated BCG disease in HIV positive children. A positive sputum smear is the gold standard for the diagnosis of TB in adults, but as children normally have a low bacterial load, they tend to be smear negative, and with the lack of other diagnostic tools, children are not diagnosed and not treated. Studies show that the diagnosis of TB can be made with acceptable accuracy following a careful assessment of clinical symptoms. Children with TB and HIV coinfection are at a much higher risk of developing serious disease, and coinfection should be suspected and treated in high burden areas.