Chronic HCV infection remains a major cause of liver disease globally, with an estimated 71 million people living with chronic HCV overall as of 2015 and an estimated 1.75 million new cases per year. However, to date less emphasis has been placed on chronic HCV in children and the prevalence, epidemiology, and natural history of infection are less well understood in children than in adults. A recent review generated modelled estimates on prevalence of infection in children aged 1-18 years. Globally, there were an estimated 3.26 million children living with chronic HCV infection; and 20 countries accounted for 80% of all cases in patients 0-18 years of age. Countries with the highest number of children with chronic HCV were: Pakistan, China, India, Nigeria, and Egypt. The predominant mode of acquisition of HCV infection in children is mother-to-child transmission, although older children and adolescents may become infected via unsafe injection practices or poor infection control practices. About 5% of infants born to mothers with HCV infection may acquire infection, which increases to up to 10% if the mother is co-infected with HIV. The risk of transmission increases with increasing maternal HCV RNA levels. Fortunately, the majority of cases in children are asymptomatic or minimally symptomatic,  and cirrhosis and hepatocellular carcinoma is rare in this age group. For this reason,  in the absence of regulatory approval and availability of formulations for pan-genoptyic DAA regimens, most professional society guidelines have recommended deferral of treatment t in younger children.. A recent global survey of policies on HCV testing and treatment in children found that most national HCV policies lack specific recommendations for HCV testing and treatment in children and adolescents, and only 33 countries had such recommendations. Updated guidance on testing and treatment is needed for younger age groups; and national elimination plans need to include case finding strategies and treatment programs for children as well as adults, children, especially those in countries with a high burden of HCV infection.