Purpose of Review <p>Managing <i>H. pylori</i> in children requires an individualized patient- and family-centered approach with careful consideration of the child’s symptoms, endoscopy results, family history, adverse effects of medications, and caregiver perspectives. Updated evidence-based consensus guidelines have been recently published. This article reviews the most recent evidence and recommendations for the management of this common infection in children.</p> Recent findings <p>Given the causal link between <i>H. pylori</i> infection and gastric cancer in adults, along with rising early-onset cancer diagnoses, infected children with a first-degree family history of gastric cancer may undergo diagnostic testing and if infection is found, treated without endoscopic evaluation. In addition, when antibiotic susceptibility is unknown and treatment is pursued, bismuth quadruple therapy from two to four weeks is a highly effective and recommended regimen for children.</p> Summary <p>Most children should be evaluated endoscopically, and treatment is strongly recommended in the setting of peptic ulcer disease as this typically correlates with symptomatic improvement for the child. In the absence of peptic ulcer disease, guidelines encourage joint decision making with the caregiver(s) and the family to determine if therapy is the best path forward. Further study is needed to identify biomarkers that predict future malignant transformation, as well as more severe gastroduodenal mucosal disease outcomes. In addition, research is critically needed, particularly in the pediatric population to develop more effective treatment regimens, and support the development of an efficacious vaccine.</p>