We describe the epidemiological and clinical aspects of louse-borne relapsing fever (LBRF) in a series of children attending in a rural hospital in Ethiopia during 1997-2007. From a total of 249 cases of LBRF, 154 (61.4%) were children (<15 years). The most frequent symptoms were: fever, headache, dizziness and musculoskeletal pains. The overall case fatality rate was 2.4 (10% for patients <1.1 years; 3.4% for 1.1 to 4.0 years; and 0% >4.0 years [P = 0.05]). The mortality in children was less than in adults (13.2%) (P = 0.003).