Helicobacter pylori infection in children and adults differs in several aspects such as the natural history, prevalence, the clinical presentations and complications, antibiotic resistance rates, treatment options, and the success rates of treatment. Due to all the abovementioned differences, management guidelines and recommendations are different between children and adults. In parallel to the steady decrease in the rate of H. pylori infection in the Western world in recent years, both in children and adults, antibiotic resistance rates have risen to alarming rates. The risk and benefits of eradication treatment, especially in children, must be considered when deciding "to treat or not." The risks include the negative effects of antibiotics, treatment failure, and reinfection as well as the possibility of losing the "protective effect" of H. pylori on atopy, allergy, and possibly on other gastrointestinal diseases. On the other hand, there are also many benefits of eradication therapy such as prevention of gastric complication and associated non-gastric complications as well as reduction of parental anxiety of nontreatment. This review summarizes the differences related to H. pylori in children versus adults and the risks and benefits of treatment in children.