Bronchiectasis is one of the diagnostic entities in the spectrum of pediatric chronic wet cough, causing significant morbidity and mortality. The pathobiology involves a vicious cycle of repeated infections, airway inflammation, dysregulated immunity, and tissue remodeling, resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated, and small-airway obstruction. Pediatric pathobiological studies are lacking, although there are recent data on the role of antibiotics in treating and preventing exacerbations. The focus has moved to understanding ways to prevent bronchiectasis and the role of novel drugs in preventing and treating bronchiectasis in children.