Tuberculosis has become a rare disease among children in Austria. Of all patients diagnosed with tuberculosis, only 3% are below the age of 14 years. Prevalence is higher in young adults (i. e. age group: 15–24 years). The disease mainly affects adolescents not born in Austria (24% versus 6%), although in children younger than 14 years the numbers are similar between native and non-native Austrians. Whereas in the adult form of lung tuberculosis widespread infiltration and cavitation is common, the child typically develops hilar lymphadenopathy. Frequently, bacteria cannot be isolated – even with bronchoalveolar lavage – and children are unlikely to infect others. Diagnosis depends mostly on the history of contact with an index patient and immunologic tests (tuberculin skin test, interferon-gamma release test), while the chest X‑ray is less sensitive, especially in very young children. This age group has the greatest risk to develop active and often progressive systemic Tbc after infection. After suspected contact with an index patient, two consecutive immunologic tests eight weeks apart can confirm (or rule out) that infection has occurred. If infection has occured, preventive therapy (nine months of isoniazid 10 mg/kg) should be offered to all children and should be enforced in children <5 years. Active tuberculosis is treated, when uncomplicated, with two months of INH + pyrazinamide + rifampicin, followed by INH + rifampicin for another four months. The therapy is usually well tolerated by children. Prognosis is excellent if the disease is restricted to the lung, but deteriorates when other organ systems are involved (e. g. meningeal involvement).