Introduction: Leprosy is a neglected tropical disease causing substantial burden in lowincome countries. Childhood cases reflect active community transmission despite global control efforts. Early diagnosis remains challenging, contributing to delayed detection and increased disability risk. Objectives: To identify and characterize barriers to early case detection contributing to diagnostic challenges in paediatric leprosy . Methods: A systematic review was conducted to evaluate diagnostic challenges and factors associated with delayed detection in paediatric leprosy . Electronic databases were searched up to February 2026 using predefined MeSH terms. Results: Nine observational studies met the criteria, with a total 1,085 patients. Three studies were conducted in India, others in Nepal, Brazil, China, and Nigeria. Diagnostic delays ranged from 11 months to 5 years. Factors contributing to delayed diagnosis were categorized into three domains: health system factors, healthcare provider factors, and socio-community factors. Limited access to primary healthcare, inadequate awareness among healthcare workers, as well as frequent misdiagnosis due to the paucibacillary and oligo-symptomatic nature of pediatric lesions were reported. A higher proportion of multi-bacillary (MB) cases was observed in late diagnosed patients. Intense social stigma and suboptimal knowledge regarding leprosy were noted in the community . Conclusion: High rates of disability and the prevalence of MB cases in children signal a failure of early detection. Addressing these requires enhancing primary healthcare worker training and augmenting community awareness to improve disease recognition. Establishing specialized referral units and providing access to advanced diagnostic modalities are essential strategies to reduce diagnostic delay and prevent long-term morbidity .