Tuberculosis (TB) remains a persistent global health crisis threatening children's health. While early diagnosis is crucial, it faces multiple challenges: non-specific clinical presentations, atypical imaging findings, and difficulties in obtaining specimens for etiological testing. Unlike in adults, immunological tests (e.g., tuberculin skin tests, interferon-gamma release assays) and etiological tests (e.g., Mycobacterium tuberculosis culture) show limited diagnostic value in children. Gene Xpert MTB/RIF(Xpert) demonstrated high accuracy in different samples including sputum, gastric fluid, stool, and etc. Furthermore, systemic barriers, including insufficient awareness and attention to childhood TB among primary care hospitals, general hospitals, and non-tuberculosis specialists continue to delay diagnosis. In this review, we describe the current status and future in childhood tuberculosis diagnosis