Extensively drug-resistant tuberculosis (XDR TB) has ex-tremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifesta-tions, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 coun-tries. These patients were managed during 1999–2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favor-able treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required.