Background: Both bone diaphyseal fractures of the forearm are common injuries in children. This study aimed to compare the functional outcomes and complications of conservative management and surgical treatment with titanium elastic nailing system (TENS) for these fractures. Methods: A total of 40 children (aged 4-14 years) with both bone diaphyseal fractures of the forearm were included in this study. Twenty patients were treated conservatively, and 20 underwent surgical treatment with TENS nailing. Functional outcomes, time to union, and complications were assessed at 6 months post-treatment. Results: The surgical group had a significantly higher proportion of patients aged ≥ 10 years (75% vs. 15%; p=0.0001) and required longer duration of surgery (95% requiring 90 minutes vs. 100% requiring < 20 minutes; p<0.001). The mean time to union was significantly shorter in the surgical group (6.70 ± 1.867 weeks) compared to the conservative group (8.80 ± 1.642 weeks) (p=0.01). The functional outcome at 6 months was excellent in 90% and good in 10% of the surgical group, compared to 80% excellent and 20% good in the conservative group (p=0.3753). Complication rates were minimal and comparable between the two groups (p=0.1060). Conclusion: TENS nailing is an effective treatment option for both bone diaphyseal fractures of the forearm in children, particularly in older children, providing faster union times with comparable functional outcomes and complication rates to conservative management.