Tuberculosis is a major unrecognized cause of disease and death in young children living in tuberculosis-endemic settings.¹ Recent estimates suggest that nearly a million children develop tuberculosis each year, although accurate quantification of the tuberculosis disease burden in children is hampered by difficulties in establishing an accurate diagnosis.^2,3 Tuberculosis case loads are highly concentrated in areas affected by poverty and social disruption, but all countries are affected owing to increased international travel, population migration, and refugee resettlement.⁴ Awareness that children have a large tuberculosis burden that is preventable and treatable has increased following calls to action in 2010 and 2011.^5,6 World Tuberculosis Day was dedicated to children in 2012, a new Roadmap for Childhood Tuberculosis launched in 2013,⁷ and a revised Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children published by the World Health Organization in 2014.⁸ Despite improved guidance and policies, implementation remains poor with major policy-practice gaps, especially regarding the provision of preventive therapy.⁹