Noninvasive tests can be used for the initial diagnosis of Helicobacter pylori infection and to monitor the success of eradication therapy. In populations with a low prevalence of H. pylori infection (children living in North America and Europe), a high sensitivity is required to make the test valuable for clinical practice. The 13C-urea breath test has been validated in children of different age groups in a significant number of infected and noninfected children in several countries and, thus far, is the only noninvasive test that fulfills sensitivity and specificity quality standards. In studies to date, enzyme immunoassays using monoclonal antibodies to detect H. pylori antigen in stool provide excellent results, but the number of children tested, particularly post-treatment, is not sufficient to recommend the test. All other noninvasive stool tests or methods based on the detection of specific antibodies in serum, whole blood, urine or saliva have limited accuracy in comparison with the 13C-urea breath test. Therefore, these tests cannot be recommended for clinical decision making in pediatric patients.