Respiratory illnesses in children are an important cause of morbidity and mortality in Africa where poverty, food insecurity, malnutrition, and human immunodeficiency virus infection are aggravating factors in many countries. These factors, in addition to under resourced health-care infrastructure, remain important barriers to improving child lung health outcomes in Africa. However, despite these challenges, there have been significant recent advancements in understanding the epidemiology, causes, measurement tools, and treatment of childhood respiratory illnesses. In this review, we highlight some advances in childhood pneumonia, tuberculosis, asthma, and other important non-communicable lung diseases common in children. Furthermore, we discuss the role of environmental influences on children’s lung health in Africa and highlight novel methods of measuring lung function in children. Although children contribute a small role in the global epidemiology of COVID-19 pandemic, socioeconomic and health-care delivery disruptions caused by government responses to contain the pandemic have resulted in significant indirect setbacks to child health. We further highlight how the COVID-19 pandemic has impacted areas of pediatric lung health and discuss ways to mitigate effects of COVID-19 in Africa.