This study examined health care preferences and influences in response to initial and persistent symptoms of typhoid fever among children in two slum communities in Karachi, Pakistan. Typhoid fever in this area is endemic and has a high rate of multi-drug resistantce. The study involved a household survey of 502 respondents. Private practitioners, including qualified medical specialists, were the preferred providers for initial symptoms, with government and private hospitals preferred for continuing symptoms. A number of cases continued to select initial health care choices regardless of the severity of symptoms. The findings point to factors of cost, access to care, previous use of a provider and perceived quality of care as key influences regarding health care choices. These findings suggest that cases of typhoid fever in these communities are at risk for not receiving appropriate diagnoses and treatment for children who are at risk for severe cases of multi-drug resistant disease. Suggestions are made for improving the care of children with typhoid in this context.