Microbiological confirmation of childhood tuberculosis is rare because of the difficulty of collection of specimens, low sensitivity of smear microscopy, and poor access to culture. This study, led by Dr Anne Detjen, from the International Union Against Tuberculosis and Lung Disease, aimed to establish summary estimates for sensitivity and specificity of the Xpert MTB/RIF assay compared with microscopy in the diagnosis of pulmonary tuberculosis in children. The researchers found that compared with microscopy, Xpert offers better sensitivity for the diagnosis of pulmonary tuberculosis in children and its scale-up will improve access to tuberculosis diagnostics for children. Although Xpert helps to provide rapid confirmation of disease, its sensitivity remains suboptimum compared with culture tests. A negative Xpert result does not rule out tuberculosis. Good clinical acumen is still needed to decide when to start antituberculosis therapy and continued research for better diagnostics is crucial.