Largely ignored by the global community, paediatric tuberculosis is a major health challenge. The clinical course of disease, presentation and diagnostics of TB in children differs from adults and poses specific obstacles making paediatric TB hard to suspect, diagnose and treat. Symptoms are often insidious and non-specific. Children are more vulnerable to severe TB disease, and this is true especially for infants under 2 years and immunocompromised children. Proper evaluation and diagnostics is even more problematic in these children as their immune systems are not fully competent. New diagnostic tools and tests are being developed; many of these are not adapted to children and not available in high-endemic, low resource settings. To achieve the goal of no TB deaths in children, private and governmental health authorities have to work together in a joint effort to enhance knowledge of the specifics of child TB, as well as improve the access to child-adapted tools and tests.