TB in Children

Over 250,000 children develop TB and 100,000 children will continue to die each year from TB

A child usually gets TB infection from being exposed to a sputum-positive adult. Young children below ten years of age are at risk of becoming infected with TB bacilli. They are also at high risk of developing active tuberculosis because the immune system of young children is less developed. The chance of developing TB disease is greatest shortly after infection. When children present with active tuberculosis disease their family members and other close contacts should be investigated for TB to find the source of the disease and treat them as necessary.

In HIV infected children the risk of developing TB meningitis is very high and often result in deafness, blindness, paralysis and mental retardation. Tuberculosis and malnutrition often go together, and a child with TB disease may present as failure to gain weight with loss of energy and a cough lasting for more than three weeks.

Diagnosing TB in children

The diagnosis of tuberculosis in children can be difficult because children under the age of 10 years usually cannot cough up enough sputum to be sent for laboratory investigations to confirm the infection of tuberculosis. The diagnosis is thus largely based on the clinical features of cough, weight loss, with a history of close contact with an infectious adult TB patient. With increasing coverage of BCG vaccination, the tuberculin skin test is no longer considered a confirmatory test. Chest X-rays of children are difficult to interpret as the typical shadow is rarely seen.

WHO Guideline for Diagnosis

Suspect TB in a child

  • Who is ill, with a history of contact with a suspect or confirmed case of pulmonary TB
  • Who does not return to normal health after measles or whooping cough
  • With loss of weight, cough, fever who does not respond to antibiotic therapy for acute respiratory disease
  • With abdominal swelling, hard painless mass and free fluid
  • With painless firm or soft swelling in a group of superficial lymph nodes
  • With signs suggesting meningitis or disease in the central nervous system

Preventing TB disease in children

  • Early diagnosis and successful treatment of an infectious adult patient is the best way to protect children from becoming infected with TB. Therefore a good TB control programme, which will ensure early diagnosis and treatment of adults with infectious form of TB is the best way to prevent TB in children
  • BCG immunization of babies soon after birth up to 2 years of age will protect them mainly against the development of TB meningitis

Treating TB in children

The management of TB in children is similar to those in adults. Some important differences are

  • Dosages in children per kilogram body weight should be higher as they have a higher metabolism. They can tolerate higher doses with fewer side-effects
  • Children usually have fewer microorganisms and are less likely to develop secondary resistance
  • Extra-pulmonary TB is more common in children and therefore the drugs used should be able to penetrate and achieve the required concentration in specific body fluids and tissues