After decades of decline, tuberculosis case rates are increasing again in the United States. Primarily because of increases in tuberculosis among persons of child-bearing years and diminished performance by some health departments, substantial increases in reported cases of tuberculosis in children have occurred since 1985. Although the clinical/radiographic presentation of intrathoracic tuberculosis in children has not changed significantly, major changes have occurred in the treatment of tuberculous disease over the past decade. This article will review the current epidemiology, diagnosis, and treatment of childhood tuberculosis.