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This study aimed to identify potential barriers and delays in the prevention of childhood TB in a low-incidence country by assessing the management of children subsequently diagnosed with TB. A pilot retrospective cohort study included children (&lt;\u200915\u00a0years) treated for TB between 2009 and 2016 at a tertiary care hospital in Berlin, Germany. Clinical data on cases and source cases, information on time points of the diagnostic work up, and preventive measures were collected and analyzed. Forty-eight children (median age 3\u00a0years [range 0.25\u201314]) were included; 36 had been identified through contact tracing, the majority (26; 72.2%) being\u2009&lt;\u20095\u00a0years. TB source cases were mostly family members, often with advanced disease. Thirty children (83.3%) did not receive prophylactic or preventive treatment, as TB was already prevalent when first presented. Three cases developed TB despite preventive or prophylactic treatment; in three cases (all\u2009&lt;\u20095\u00a0years), recommendations had not been followed. Once TB was diagnosed in source cases, referral, assessment, TB diagnosis, and treatment were initiated in most children in a timely manner with a median duration of 18\u00a0days (interquartile range 6\u201360, range 0\u2013252) between diagnosis of source case and child contact (information available for 35\/36; 97.2%). In some cases, notable delays in follow-up occurred.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Prompt diagnosis of adult source cases appears to be the most important challenge for childhood TB prevention. However, improvement is also needed in the management of exposed children.\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022\u00a0Following infection with Mycobacterium tuberculosis, young children have a high risk of progression to active and severe forms of tuberculosis (TB).<\/jats:italic><jats:italic>\u2022 The risk of infection and disease progression can be minimized by prompt identification of TB-exposed individuals and initiation of prophylactic or preventive treatment.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022\u00a0We could show that there are avoidable time lags in diagnosis in a relevant proportion of children with known TB exposure.<\/jats:italic><jats:italic>\u2022 Delayed diagnosis of adult source cases, losses in follow-up examinations, and delay in referral to a specialized TB clinic of TB-exposed children, especially among foreign-born children, appear to be the main issue in this German pediatric study cohort.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04537-1","type":"journal-article","created":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T06:05:24Z","timestamp":1656569124000},"page":"3299-3307","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pilot study to identify missed opportunities for prevention of childhood tuberculosis"],"prefix":"10.1007","volume":"181","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4171-1098","authenticated-orcid":false,"given":"Cornelia","family":"Feiterna-Sperling","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Thoulass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renate","family":"Kr\u00fcger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter","family":"Haas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Hauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"key":"4537_CR1","unstructured":"World Health Organization (2020) Geneva, Switzerland. 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