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TB and 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 guidelines 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.
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