BACKGROUND: Respiratory tract infections (RTIs) and tuberculosis (TB) impose a critical global health burden on children, serving as leading causes of morbidity and mortality. Lower respiratory tract infections (LRIs) remain the primary cause of death in under-5 s, though mortality has declined recently. OBJECTIVE: This study aims to analyze trends in RTIs and TB among 0-14-year-olds using Global Burden of Disease (GBD) data from 1990 to 2021. METHODS: Global data on childhood RTIs and TB were collected from GBD, with standardized methods used to assess disease burden trends, age/sex/SDI differences, and the contribution of 11 risk factors. RESULTS: From 1990 to 2021, incidences of upper RTIs, otitis media, and TB decreased, but overall RTIs increased. Neonatal LRI had the highest mortality (1,560.6/100 k). Male children showed higher TB incidence/mortality. Low-SDI areas had the highest burden (mortality 2.036/100 k), while high-SDI areas saw the largest TB mortality drop (95.7%). Underweight remained the main risk factor, with DALY rate falling 80.3%, though household air pollution, low birth weight, short gestation, and high temperature rose in rank. CONCLUSION: Global childhood respiratory disease burden faces challenges, requiring strengthened international cooperation and targeted interventions, especially in low-SDI regions, to improve public health and nutrition.