BACKGROUND: Paediatric pulmonary TB is the most neglected aspect of the present case scenario and is completely different from adult TB. Compliance to TB treatment in children is important to prevent drug resistance and mortality which includes multiple patient-related and healthcare-related factors. Globally treatment non-compliance remains the major hindrance to achieve complete cure and interventions done to improve treatment compliance will be a major breakthrough. METHODS: In this cross-sectional observational study, a semi-structured questionnaire was used to find out the socio-demographic factors and the factors determining treatment compliance among paediatric pulmonary tuberculosis subjects registered at treatment units under DTCO, Hyderabad, Telangana. MMAS-8 scale which was validated had been used to assess treatment compliance. Chi-squares and fisher’s exact test were used for statistical analysis. RESULTS: Out of 88 paediatric pulmonary TB respondents that have been registered under 19 TUs, 15 children (17%) have shown treatment non-compliance. The study revealed children with age <5 years (30.7%), males (18.5%), Hindus (27%), high school going (30.4%), with positive migration history (22.2%), underweight category (19.4%), lower socioeconomic class (19%), treatment access from private health setup (20%) and parents with lack of basic TB knowledge (19%) have shown greater non-compliance. Reasons for missing out on medication in this study were forgetfulness, adverse drug reactions, lack of paediatric drug formulations, lack of prior awareness, and feeling cured. CONCLUSION: In-spite of robust TB programs and free supply of medicines by the government still there is a significant non-adherent population constituting 17% of the total pulmonary TB respondents. The above mentioned factors for treatment non-compliance should be addressed with careful attention to achieve complete treatment compliance.