Despite downward trends in the overall rate of tuberculosis in the United States for 1993 to 1994, the rate among children (0 to 14 years) has increased. To evaluate the trend in pediatric tuberculosis in Chicago and better direct public health efforts to control tuberculosis, we analyzed summary data for 1974 to 1981 and detailed data for 1982 to 1994 from surveillance case reports. These data were compared to the 1980 and 1990 census data for the 77 community areas in Chicago. Of the 18,700 cases of tuberculosis reported in Chicago for the study period, 702 (3.8%) occurred in children. Children accounted for a significantly increasing proportion of reported cases, 204/7093 (2.9%) in 1974 to 1981 versus 498/11,607 (4.3%) in 1982 to 1994, a trend which began in 1982. The number of cases among immigrants remained low throughout the study. Sites of infection were as follows: 73% pulmonary parenchymal disease, 9% hilar adenopathy, 9% extrathoracic lymph adenopathy, 3% meningitis, 3% miliary, and 3% other. From 1982 to 1994, 13 communities had a total of 224 cases (45%); average rates were > 10/100,000 in the population under 15 years old, and 7 of these communities had 127 cases (25%); average rates were > 15/100,000. Of the 77 community areas, 16 (21%) had no pediatric tuberculosis. Comparison of case rates with socioeconomic and health indicators showed the highest rates in communities with multiple indicators of poverty, including overcrowded housing units, low median income, and high infant mortality rates. Pediatric tuberculosis in Chicago remains a significant public health problem. Efforts to address this problem should provide resources to the community areas with the highest incidence rates.