Neglected tropical diseases affect poor and marginalized populations, with children especially neglected. For sleeping sickness (human African trypanosomiasis), treatments can either be too toxic for children (such as for the Trypanosoma brucei rhodesiense parasite) or problematic to administer (intravenous administration). Although there is currently an effective oral treatment for adults, the dosage of this drug (fexinidazole) does not include children younger than six years of age or weighing less than 20 kg or those with advanced disease. As there is only one oral drug (miltefosine) for the life-threatening kalaazar (black fever or visceral leishmaniasis), combination therapies inevitably include one or more injectable drugs, which are painful or cumbersome to administer to children. For snail fever (schistosomiasis), no paediatric formulations are currently available. For current treatment of river blindness (onchocerciasis) through mass drug administration, children weighing less than 15 kg are excluded because there is no approved dosing for this category or suitable paediatric formulation. For Chagas disease, a hidden, silent disease, even though two effective paediatric treatments are available, uptake is very low, necessitating greater political will and commitment to change the situation.