Introduction: Tuberculosis (TB) is among the top ten cause of death from a single infectious agent worldwide. It is also among the top 10 causes of death among children. Globally, there are estimates of 1.3 million cases of tuberculosis in children seen per year. More than 90 % of TB cases and deaths occur in developing countries. Treatment outcome results serve as a proxy of the quality of TB treatment for children and as well as adults provided by a health care system. In Ethiopia, data on pediatric TB treatment outcomes are limited. Objective: The objective of this study was to determine pediatric tuberculosis treatment outcomes and associated factors in health facilities of Shashemene town, Oromia region, Ethiopia, 2019. Methods: Institutional based retrospective cohort study design was conducted from February 10 to March 10, 2019 at Shashemene town, Oromia region, Ethiopia. By simple random sampling method, 390 registered TB patients who had known treatment outcomes were selectedfrom Unit TB register logbook. After the data were collected, it was entered to Epi Info version 7, and analyzed with SPSS version 23 software. Descriptive statistical were used to summarize patients’ characteristics and determine the magnitudes of treatment outcomes. The variables that found to be significant at p-value < 0.25 in the bivariate analysis were entered to multivariable logistic regression. Multivariable logistic regression model was used to find factors associated with pediatrics tuberculosis treatment outcomes. Result: Of the total 390 children, 201(51. 5%) were females, 138(35.4%) were under 5 years old, 373(95. 6%) of them were new cases. The types of TB were pulmonary smear-negative TB accounted for more than half 213(54.6%) of childhood TB, EPTB accounts 140(35.9%) and pulmonary smear-positive TB accounts for 37(9.5%). According to this study, the overall treatment success rate was 356(91.3%). Of total 390 patients, 25(6.4%) were cured, 331(84.9%) were treatment completed, 12(3.1%) were lost to follow up, 17(4.4%) were deaths, and 5(1.3%) were treatment failures. On multivariable logistic regression analysis, age group 1-4 years, 5-9 years, 10-14 years, rural residence and HIV negative sero-status were independently associated with poor treatment outcome. Conclusions and Recommendations: According to this study, the treatment success rate was above End TB Strategy. The treatment outcome was considerably varied with age, HIV status and residence of the patient. Young children less than 1 year, HIV co-infected and those patients with rural residence need special attention to reduce poor treatment outcomes among children.