Objective: The objective of this study was to assess of factors affecting adherence of pediatric TB patients to anti TB drugs in Adama referral hospital. Methodology: Retrospective cross sectional study has been conducted from March 19th to May 20th, 2014 to assess factors affecting adherence of pediatrics TB patients to anti TB drugs in Adama referral hospital. Data collection format was used to collect data from available data sources such as patients’ medical cards and DOT registration book. Simple random sampling technique has been used in this research and data was presented in table and categorized and analyzed by using SPSS computer software package.