Tuberculosis (TB) In Children: All You Need To Know

Chronic cough is not always tuberculosis. While there are many myths and facts surrounding this terrible disease, Dr NC Gowrishankar throws some light on what to believe and what not to!

By Ashwin Dewan

Tuberculosis (TB) In Children: All You Need To Know
Watching your child cough is not easy

According to the Tuberculosis (TB) Report 2018, released by the World Health Organization (WHO), an estimated 27.4 lakh Indians suffered from TB in 2017. While that is a worrying statistic, what’s even more disturbing is the fact that our nation still suffers from low awareness on this dreaded disease. So, what can you, as a parent, do to ensure your child remains protected? If you are a parent whose child is suffering from TB, do not get stressed over it. Apart from the medicine prescribed by the doctor, there are other ways to help your child recover fast.

ParentCircle interacted with Dr NC Gowrishankar, Deputy Head, Paediatrics at Dr Mehta’s Children's Hospital, Chennai, to understand in detail, the causes, symptoms, diagnosis and 'myths versus facts' related to TB.

What is tuberculosis?

Tuberculosis is a severe bacterial infection that infects the lungs. Sometimes, the other organs of the human body like the kidneys, spine or the brain can also get affected. Primarily an airborne disease, TB in children can be fatal if not detected and treated early.

In children, TB can occur within the lungs in the form of pneumonia. It can also occur outside the lungs, but inside the chest cavity, in the form of fluid accumulation or enlargement of lymph nodes.

What is the difference between latent and active TB?

In some cases, people may be affected with tuberculosis, but they do not feel sick. This is called latent 'sleeping' TB infection. In others, the TB germs multiply in the body at an active rate, causing tissue damage. This is known as active TB disease. Often, tuberculosis can remain dormant in a person for many years. Although not common, latent TB can develop into an active TB infection.

Common TB symptoms in children to watch out for:

  • Persistent fever that lasts two weeks or more
  • A chronic cough that lasts two weeks or more
  • Drastic weight loss
  • Loss of appetite
  • A general feeling of weakness and fatigue
  • Swollen glands and vomiting

Remember…

Not many are aware that even an eye infection like uveitis can be a symptom of TB. Uveitis, which is the most ‘common ocular manifestation’ of TB, results in inflammation in the eye, produces swelling and causes redness. If not diagnosed early and treated in time, uveitis can damage the eye.

How does a child contract TB?

In most cases, it has been observed that children contract tuberculosis from an infected parent, who has been diagnosed with TB but has not taken proper treatment. Usually, a child becomes infected when she has repeated contact and exposure to the TB bacteria. It does not matter if a child is physically healthy or weak.

Few other factors may also play a part in the child contracting the disease. For instance, poor ventilation that leads to accumulation of bacteria, the absence of sunlight and lack of proper medication, might lead to children becoming vulnerable to contracting TB.

Is TB contagious?

Tuberculosis is contagious, but the infection does not spread easily. It is only with repeated and continuous exposure to a person with active TB bacteria that one can get infected with this disease. TB does not spread through personal items such as clothing, utensils and bedding.

Can TB be transmitted from a pregnant woman to her child?

Yes, it is possible for a pregnant woman suffering from tuberculosis to transmit the disease to her child. However, this situation can be prevented by proper treatment of the affected mother. Once a pregnant woman is diagnosed with tuberculosis, treatment should begin immediately and must include anti-tuberculosis drugs, which can be used without any threat to the unborn baby.

TB medicines should be taken regularly as TB bacteria are known to die very slowly.

How do doctors diagnose TB in children?

Doctors have many ways of diagnosing tuberculosis in children. The family history of the infected patient is one of the important considerations. Some other ways to diagnose TB in children include:

  • Close examination of the child’s chest
  • Presence of enlarged lymph glands in the child's neck
  • A skin test called Mantoux is done to determine if someone might have developed an immune response to the bacterium that causes tuberculosis
  • X-rays of the chest
  • Blood tests including one that determines the white blood cell count
  • Sputum test where doctors take samples of the sputum, which is the mucus that comes out when one coughs. The samples are tested to assess the TB bacteria resistance of the patient.

How is TB treated?

Medicine plays a vital role in treating TB in children, but the recovery process takes slightly longer than other types of bacterial infections. Antibiotics must be taken for at least six to nine months. The treatment process (including the medicine prescribed) depends on the age, overall health and possible drug resistance.

What are the side effects of TB medication?

Usually, there are no major side effects of TB medicine on children and expecting mothers. However, one should remember that any TB medicine contains chemicals, which can have negative side effects. For instance, the child can experience vomiting sensation. In some cases, if a child’s liver gets affected by medication that goes undetected, then giving the child medicine without monitoring the dosage can further affect the functioning of the liver.

What happens if the prescribed medicine is not taken regularly?

TB medicine should be taken regularly as TB bacteria are known to die very slowly. It requires a minimum period of six months to kill the bacteria. One might feel well after a few weeks and discontinue the medicine, but the bacteria are not eliminated. If one does not complete the entire course of medication, TB bacteria can grow and become resistant to the medicine.

When can a child with TB resume school?

It depends on the severity of the infection. An infected child can go to school but stay away from activities that require physical exertion. In case a child has fever, he should rest at home. Also, parents should always consult the doctor before taking any decision.

Does diet play a key role?

A highly balanced and nutritious diet can play a significant role in the recovery process of children diagnosed with TB. A protein-rich diet is good for a child infected with TB. Go for eggs, milk and groundnuts.

Tuberculosis (TB) In Children: All You Need To Know

How does one deal with the stigma associated with TB?

Unfortunately, there is some social stigma attached to a person suffering from tuberculosis. One must not unnecessarily worry about contracting the disease from an infected person. There is also no need to resort to extreme measures such as keeping the patient in a separate room, making him sleep on a separate bed or using separate utensils.

Those affected with TB, especially children, need our full physical, emotional and mental support to combat the disease and make a quick recovery.

The government is taking substantial efforts to tackle the menace of tuberculosis. This includes tackling the stigma associated with it by raising awareness through campaigns, providing the medicine and treatment at a nominal cost, if not for free.

It is also up to all of us to play our parts in driving away the stigma associated with TB and raise necessary awareness about the disease.

6 common myths and facts about TB

1. Myth: People who exercise are not in danger of contracting tuberculosis.

Fact: Even healthy people can contract tuberculosis.

2. Myth: Tuberculosis is a hereditary disease.

Fact: Genetics has no role to play in contracting tuberculosis.

3. Myth: Tuberculosis usually affects the lower socio-economic class.

Fact: Tuberculosis can affect anyone irrespective of their socio-economic background and living conditions.

4. Myth: Tuberculosis affects only the lung.

Fact: Tuberculosis affects any organ in the body.

5. Myth: Seasonal cough is sometimes mistaken for tuberculosis.

Fact: Seasonal cough is normal and goes away on its own.

Myth: People who eat right cannot get tuberculosis.

Fact: A healthy and nutritious diet does not ensure protection against tuberculosis.

So, that was some valuable information on this dreaded disease. Let us all come together and take a pledge to help eliminate tuberculosis from the society so that our future generations are safe and secure from tuberculosis.

Dr N C Gowrishankar is a renowned Paediatric Pulmonologist. He is currently the Deputy head - Paediatrics at Dr Mehta’s Children’s Hospital.

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