Summary: Managing Helicobacter pylori (H.pylori) in children and adolescents requires an individualized approach with careful consideration of the patient's symptoms, family history, endoscopic evaluation, potential adverse effects of treatment and caregiver's perspective. In a vast majority of children infection remains asymptomatic and rarely causes complications. Moreover, there is growing evidence for a role of H.pylori infection in reducing the risk of some chronic diseases like asthma. As a result, the indications for testing and treatment in pediatric population are limited. Invasive testing and subsequent H. pylori therapy should be performed in children with gastric or duodenal ulcers and/ or erosions and with refractory iron deficiency anemia in whom other causes of anemia have been ruled out. Children with a first- -degree family history of gastric cancer may undergo non-invasive diagnostic testing and be treated without endoscopy when confirmed H.pylori positive. Since the frequency of resistance is increasing worldwide, determination of antimicrobial susceptibility is suggested to tailor the eradication scheme. When antibiotic susceptibility is unknown a bismuth-based quadruple therapy for 10–14 days is recommended as first-line eradication therapy. Some probiotics given as adjunctive treatment may enhance H.pylori eradication rates and reduce gastrointestinal side effects.