Background and Objectives. Migration flux is an increasing phenomenon in Italy and it raises several public health issues and concerns about pediatric infectious diseases. To investigate pediatric TB in the Northern Sardinia.Design. We performed a cross-sectional analysis of clinical records available for 6 years (2009-2014) at the only referral Center for both symptomatic TB-infected children and TB-exposed household contacts.Results. Two-hundred-forty-six children (mean age = 5.8 ± 3.9 years) were identified, among whom 222 (90.2%) were natives and 24 (9.8%) immigrants. The majority of children (n=205; 83%) were TB-exposed but not infected, because negatives to both TB skin test (TST) and thorax X-ray (TX). Among the TST positive group (n= 39; 16%), 19 (49%) had latent TB infection (TX negative), while 20 (51%) had active TB (TX positive). The percent of TST positive children was significantly higher in the immigrant than native group (42.5% versus 14%, p < 0.001). Clinical presentations were pulmonary involvement with hilar lymphadenopathy (72%), pleurisy (13,5%), latero-cervical lymphadenopathy (9%), pneumonia with calcifications (4.5%) and disseminated TB (4.5%). One child had multidrug-resistant tuberculosis.Conclusion. Pediatric TB represents a relevant and potentially worsening public health problem in Northern Sardinia. A strict surveillance system and appropriate treatment can prevent the most severe forms and reduce TB transmission.