This study aimed to evaluate the current challenges in diagnosing and managing pediatric tuberculosis in the Republic of Moldova, with an emphasis on post-pandemic epidemiological dynamics. A retrospective observational study was conducted on 772 children aged 0–18 years diagnosed with TB and hospitalized at the IMSP Municipal Clinical Hospital of Phthisiopneumology, Chișinău, between 2019 and 2024. Data were collected from clinical records and the national TB monitoring system (SIME TB). Epidemiological context, risk factors, diagnostic pathways, clinical manifestations, and treatment outcomes were analyzed. Statistical analysis included both descriptive and inferential methods using Excel and SPSS, with calculation of odds ratios and confidence intervals to assess associations between variables. The incidence of pediatric TB followed a fluctuating trend over the last decade, with a marked decline during the COVID-19 pandemic and a sharp increase in 2023–2024 due to delayed case detection. Most cases (74%) were identified through active screening of household contacts. The age group 6–14 years was most affected (49%), though a significant proportion (34%) involved children under five. TB was associated with multiple risk factors in 67% of cases, particularly social vulnerability and comorbidities. The most common clinical forms included intrathoracic lymph node TB (56%) and primary TB complex (21%). Microbiological confirmation was achieved in 37% of cases. Complications such as pleurisy (13%) and atelectasis (11%) were frequent. Most patients responded favorably to standard anti-TB regimens, with only one recorded death.