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Tuberculosis in Children and Teens

​Each year in the United States, there are about 9,000 new cases of tuberculosis (TB). TB is a rare but contagious disease caused by a bacterium called Mycobacterium tuberculosis. It primarily affects the lungs, but can also target parts of the body.

While the disease is less common than it once was, some groups of children and teens have a high risk of getting this germ. Here's what parents should know.

Who is at risk for TB infection?

Children and teens at higher risk include those who:

  • Are living in a household with an adult who has active tuberculosis

  • Were born in a country that has a high prevalence of TB

  • Are visiting a country where TB is endemic and who have extended contact with people who live there

Some groups of children have a high risk of severe disease if they become infected. These include:

  • Children who are younger than 4 years old, or teenagers who have started puberty

  • Children who have a problem with their immune system (including those who are infected with HIV, or take medications that will decrease their body's immune system)

How does TB spread?

Tuberculosis usually is spread when an infected adult coughs the bacteria into the air. These germs are inhaled by the child or teen, who then becomes infected.

Children younger than about 12 years old with TB of the lungs rarely infect other people. This is because young children tend to have very few bacteria in their mucus secretions. Also, their coughs typically do not spread germs as effectively as when adults coughs.

Symptoms of TB

Fortunately, most children and adolescents exposed to tuberculosis don't become ill. When the bacteria reach their lungs, the body's immune system attacks the germs and prevents further spread. This symptom-free infection can only be identified by a positive blood test or skin test. However, even if your child has a symptom-free infection, they still must treated. This is to reduce the risk that, in the future, the infection will worsen into disease.

Occasionally, in a small number of children or teens without proper treatment, the infection does progress. It can cause fever, fatigue, irritability, a persistent cough, weakness, heavy and fast breathing, night sweats, swollen glands, weight loss, and poor growth.

In an even smaller number of those infected with TB--mostly those less than four years old, adolescents who have started puberty, or anyone with a weakened immune system--the TB germ spreads through the bloodstream. When this happens, it can affect virtually any organ in the body. This type of TB illness requires complicated treatment. The earlier it is found and the treatment is started, the better the outcome.

How is TB diagnosed?

If your child is at risk for getting TB or having severe disease, they should be tested. The type of test depends on the age of the person:

  • If younger than 2 years old, they should receive a tuberculin skin test (usually called a TST, and also called the TB skin test).

  • If 2 years of age or older, they can have blood drawn for a test called an interferon-gamma release assay (usually called an IGRA, and also called the TB blood test). A skin test can be done on older children, but the blood test is preferred.

Your child may need a TB blood test or TB skin test if you answer yes to at least one of the following questions:
  • Has a family member or contact had tuberculosis disease?

  • Has a family member had a positive TB blood test or TB skin test?

  • Was your child or teenager born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)?

  • Has your child or teenager traveled (had contact with resident populations) to a high-risk country for more than one week?

  • Does your child or teenager have a weakened immune system?

The IGRA test is done by having blood drawn into a tube, which is then sent to a laboratory. The laboratory will test the blood for the IGRA, and results will be sent to your pediatrician.

The TST is performed in your pediatrician's office by injecting purified, inactive pieces of the TB germ into the skin of the forearm. If there has been an infection, your child's skin will swell and redden at the injection site. Your pediatrician will check the skin forty-eight to seventy-two hours after the injection, and measure the diameter of the reaction.

Both the IGRA (TB blood test) and TST (TB skin test) means that your child's body has experienced the bacteria, even if the child has had no symptoms and even if their body has fought the disease successfully. Neither of the TB blood test nor the TB skin test will actually cause or worsen a TB infection.

Treatment for TB

  • If your child's TB blood test or TB skin test is positive: A chest X-ray will be ordered to determine if there is evidence of active or past infection in the lungs. If the X-ray does indicate the possibility of active infection, your pediatrician also will search for the TB bacteria in your child's cough secretions or in their stomach. This is done in order to determine the type of treatment needed.

  • If your child's TB blood test or TB skin test is positive, but they do not have symptoms or signs of active tuberculosis infection: They are still infected. Your pediatrician will prescribe medications to reduce the risk of the infection getting worse. The type of medication is based on what is best suited for your child's age, ability to swallow pills, and whether the medication is taken at home or at the pediatrician's office.

  • For an active tuberculosis infection: Your pediatrician will prescribe three or four medications. You will have to give these to your child for 6 to 12 months. Your child or teenager may have to be hospitalized at first to get treatment is started, although most of it can be carried out at home.

It is very important that children or anyone being treated for tuberculosis finish the medicine and take the drugs exactly as instructed.

Controlling the spread of TB

If your child has been infected with TB, regardless of whether they develop symptoms, it's very important to try to identify the person they caught it from. Usually this is done by looking for symptoms of TB in everyone who came in close contact with your child. The most common symptom in adults is a persistent cough, especially one that is associated with coughing up blood.

A TB blood or TB skin test may be recommended for all family members, babysitters, and housekeepers. Anyone who has a positive TB blood test or TB skin test should be examined by a medical provider, get a chest X-ray, and start treatment.

When an active infection is found in an adult: The adult should be isolated as much as possible–especially from young children–until treatment is under way. All family members who have been in contact with that person usually are also treated with INH, regardless of the results of their own TB blood test or TB skin test. Anyone who becomes ill or develops an abnormality on a chest X-ray should be treated as an active case of tuberculosis.

If an adult with an active infection is untreated: Tuberculosis can be controlled by the immune system for many years, only to break free during adolescence, pregnancy, or later adulthood. At that time, not only can the individual become quite ill, but they also can spread the infection to those around them. That's why it is very important to have your child or teenager to be tested for TB if they come in close contact with any adult who has the disease. This helps ensure they can get get prompt, appropriate treatment if their TB blood test or TB skin test is positive.

Remember

Talk with your pediatrician if you have any questions about TB or other infectious diseases.

More information

Last Updated
11/22/2021
Source
American Academy of Pediatrics (Copyright © 2021)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.