From gaps to progress: five-year global advances in the diagnosis of pediatric tuberculosis.

Background: Pediatric tuberculosis (TB) remains a major global health challenge, characterized by age-specific difficulties especially in diagnosis compared to adults. This review summarizes key advances in pediatric TB diagnostics over the past five years. Methods: Literature was retrieved from PubMed/MEDLINE, Embase, Web of Science, Scopus, the Cochrane Library, and Google Scholar. Priority was given to multi-center pediatric cohort studies, diagnostic accuracy studies, implementation studies, and evidence that informed international guidelines. Advances: In diagnosis, the field is shifting from reliance on conventional bacteriology toward a multidimensional approach integrating molecular diagnostics, host biomarkers, and artificial intelligence (AI)-assisted imaging. This approach addresses challenges arising from the paucibacillary nature of pediatric TB and difficulties in specimen collection. Recent advances include expanded use of rapid molecular assays on non-sputum specimens, the development of host-response biomarkers primarily for triage and risk stratification, and emerging but still limited applications of AI-assisted chest radiography for screening in pediatric populations. Conclusion: Although pediatric TB care has moved from an adult-centric evidence paradigm to an increasingly child-specific evidence base, substantial gaps persist between diagnostic evidence and real-world implementation, especially in high-burden, resource-constrained settings. Future efforts should prioritize scalable, child-centered diagnostic strategies that can be integrated into decentralized care pathways, with particular attention to infants and other vulnerable groups. Strengthening diagnostic access and implementation will be critical to advancing global End TB goals for children.