Tuberculosis (TB) in Children

What is tuberculosis in children?

Tuberculosis (TB) is an ongoing (chronic) infection caused by bacteria. It usually infects the lungs. But other organs such as the kidneys, spine, or brain may be affected. TB is most often spread through droplets breathed or coughed into the air. A child can be infected with the TB bacteria and not have active disease.

The stages of TB are:

  • Exposure. This occurs when a child has been in contact with a person who may have or does have TB. The child will have a negative skin test, a normal chest X-ray, and no symptoms.

  • Latent TB infection. This occurs when a child has TB bacteria in his or her body, but does not have symptoms. The infected child’s immune system causes the TB bacteria to be inactive. For most people who are infected, the TB will be latent for life. This child would have a positive skin test but a normal chest X-ray. He or she can't spread the infection to others.

  • TB disease. This is when a child has signs and symptoms of an active infection. This child would have a positive skin test and a positive chest X-ray. He or she can spread the disease if untreated.

What causes TB in a child?

TB is caused by bacteria. It’s most often caused by Mycobacterium tuberculosis (M. tuberculosis). Many children infected with M. tuberculosis never develop active TB and remain in the latent TB stage.

TB bacteria is spread through the air when an infected person coughs, sneezes, speaks, sings, or laughs. A child usually does not become infected unless he or she has repeated contact with the bacteria. TB is not likely to be spread through personal items, such as clothing, bedding, cups, eating utensils, a toilet, or other items that a person with TB has touched. Good air flow is the most important way to prevent the spread of TB.

Which children are at risk for TB?

TB can grow and cause an active disease in a child with a weak immune system. This can include children who:

  • Have HIV

  • Have diabetes

  • Are being treated with medicine that can weaken the immune system, such as corticosteroids or chemotherapy

Very young children are more likely than older children to have TB spread through their bloodstream and cause complications, such as meningitis.

A child is more at risk for TB if he or she:

  • Lives with someone who has TB

  • Is homeless

  • Comes from a country where TB is common

  • Has a weak immune system

What are the symptoms of TB in a child?

Symptoms can occur a bit differently in each child, and they depend on the child's age. The most common symptoms of active TB in younger children include:

  • Fever

  • Weight loss

  • Poor growth

  • Cough

  • Swollen glands

  • Chills 

The most common symptoms of active TB in adolescents include:

  • Cough that lasts longer than 3 weeks

  • Pain in the chest

  • Blood in sputum

  • Weakness

  • Tiredness

  • Swollen glands

  • Weight loss

  • Decrease in appetite

  • Fever

  • Sweating at night

  • Chills

The symptoms of TB can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is TB diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam.

TB is diagnosed with a TB skin test. In this test, a small amount of testing material is injected into the top layer of the skin. If a certain size bump develops within 2 or 3 days, the test may be positive for TB infection.

Your child may also need a chest X-ray and sputum test. A blood test called interferon-gamma release assays (IGRA) may also be done.  

A TB skin test is advised for children who:

  • May have been exposed to TB in the last 5 years

  • Has an X-ray that looks like TB

  • Has any symptoms of TB

  • Comes from a country where TB is common

Yearly skin testing should be done on children who:     

  • Have HIV

  • Are in a detention facility

A child who is exposed to high-risk people should be tested every 2 to 3 years.

A child may get TB skin testing from ages 4 to 6 and 11 to 16 if he or she:

  • Has a parent from a high-risk country

  • Has traveled to a high-risk area

  • Lives in a densely populated area

How is TB treated in a child?

Treatment may include a short-term hospital stay to be treated with medicine.

For latent TB, the child is given a 6- to 12-month course of the medicine isoniazid. Or the child may get a shorter course of another medicine. For active TB, a child may take 3 to 4 medicines for 6 months or more. This is to make sure that the medicine is working.  

Children usually start to get better within a few weeks of starting treatment. After 2 weeks of treatment with medicine, a child is usually not contagious. Treatment must be fully finished as prescribed. It is important that your child take all of the medicines for the entire time period.

Talk with your child’s healthcare provider about the risks, benefits, and possible side effects of all medicines.

How can I help prevent TB in my child?

TB can be prevented by lowering your child’s risk for the disease.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse

  • New symptoms

Key points about TB in children

  • Tuberculosis (TB) is an ongoing (chronic infection) caused by bacteria. It usually infects the lungs. But other organs such as the kidneys, spine, or brain may be affected.

  • A child can be infected with TB bacteria and not have active disease.

  • The most common symptoms of active TB include fever, cough, weight loss, and chills.

  • TB is diagnosed with a TB skin test, chest X-ray, and blood test.

  • Treatment may include a short-term hospital stay to be treated with medicine.

  • TB can be prevented by lowering your child's risk for the disease.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

  • Ask if your child’s condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if your child does not take the medicine or have the test or procedure.

  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.