Background: The diagnosis of childhood pulmonary tuberculosis among medical doctors has presented serious challenge in tuberculosis case finding in resource poor settings.Aim of the study: To determine the use of recommended score chart among medical doctors; and to compare the ranking of diagnostic clinical features of childhood pulmonary tuberculosis between users and non users of tuberculosis score chart (TSC) among medical doctors.Methodology: A cross sectional study, using structured questionnaires to collect data from medical doctors who provided care to children in some selected health facilities in southeastern Nigeria.Results: Majority (82.8% or 183 of 221) of the subjects did not use tuberculosis score chart. The ranking of symptoms by all respondents were persistent non remitting cough (1), weight loss or failure to thrive (2&3), history of contact with adult with smear positive tuberculosis (4), radiographic abnormalities (5). Weight loss and failure to thrive was scored highest in ranks (2) and (3). There was a difference in the ranking of TSC users, where fever was ranked (3), followed by history of contact, whereas the non TSC users ranked history of contact, twice (3& 4). There was a falling trend in the percentage scores in the ranking by both TSC and non TSC users.Conclusions: Most medical doctors who provided care to children did not use National Tuberculosis and Leprosy Control Programme’s Tuberculosis Score Chart in the diagnosis of childhood pulmonary tuberculosis.