The government never tires of educating the public, especially parents, on how to prevent stunting. This is also related to tuberculosis (TB), often referred to as TBC in children, which is one of the risk factors that can cause stunting.
To understand the connection between stunting and TBC in children, here’s the explanation.
What is TBC in Children?
According to the explanation on the University of Rochester Medical Center (URMC) website, tuberculosis (TB) is a chronic ongoing infection caused by bacteria that usually infect the lungs, although other organs such as the kidneys, spine, or brain can also be affected.
This means the disease should not be taken lightly.
Where Do Children Get TB From?
TB most commonly spreads through inhaled droplets from coughs or sneezes in the air. A child can be infected with TB bacteria in several ways:
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Exposed: Transmission occurs when a child comes into contact with someone who has TB, but the child’s skin or blood tests are still negative, chest X-rays are normal, and there are no symptoms.
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Latent TB Infection: This happens when a child has TB bacteria in their body but shows no symptoms. The child’s immune system keeps the TB bacteria inactive. For most infected people, TB remains latent for life. Skin or blood tests are positive, but chest X-rays are normal, and there are no TB symptoms. The child cannot spread the bacteria to others.
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TB Disease: This is when a child shows signs and symptoms of active infection. The child may have positive or negative TB skin or blood tests, and testing shows active TB in the lungs or elsewhere in the body. The child can spread TB if the infection is in the lungs and not treated promptly.
Tuberculosis is a preventable and curable disease. However, according to WHO findings, it continues to affect millions of children and adolescents.
Children and young adolescents under 15 years old represent about 11% of all TB cases globally.
This means 1.1 million children and young adolescents under 15 fall ill with TB each year, and over 225,000 of them die.
What Causes TB in Children?
TB is caused by bacteria, most commonly Mycobacterium tuberculosis (M. tuberculosis).
Many children infected with M. tuberculosis never develop active TB and remain in the latent stage.
TB bacteria spread through the air when an infected person coughs, sneezes, talks, sings, or laughs. A child usually does not get infected unless they have repeated contact with the bacteria.
TB is not transmitted through personal items, such as clothing, bedding, cups, utensils, toilets, or other objects previously touched by someone with TB.
Which Children Are at Risk of TB?
Any child can develop TB after exposure, but they are at higher risk if they:
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Live with someone who has TB
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Are homeless
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Come from a country with high TB prevalence
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Have a weakened immune system, including from diabetes, HIV, or taking medications that suppress immunity
Compared to older children, younger or smaller children are generally more likely to develop TB exposure through their bloodstream, which can lead to complications like TB meningitis or disseminated TB.
The Centers for Disease Control and Prevention (CDC) explains that people with pulmonary or throat TB can spread bacteria to those they spend daily time with. However, children are less likely to spread TB to others.
This is because TB in children is usually less contagious than TB in adults.
What Are the Symptoms of TB in Children?
TB symptoms in children can vary slightly depending on their age. Common active TB symptoms in young children include:
- Fever
- Weight loss
- Poor growth
- Cough
- Swollen glands (some may start draining fluid through the skin)
- Chills
Common active TB symptoms in older children include:
- Cough lasting more than 3 weeks
- Chest pain
- Blood in sputum
- Severe fatigue
- Swollen glands (some may start draining fluid through the skin)
- Weight loss
- Loss of appetite
- Fever
- Night sweats
- Chills
If observed closely, the symptoms above are very common or similar to those of other illnesses.
Therefore, to ensure your child is not infected with TB, it’s best to have them examined by a doctor for an accurate diagnosis.
“Believe it or not, many children are found to have tuberculosis infections after further examination,” said pediatric specialist Dr. Meta Herdiana Hanindita, Sp.A(K).
What Is the Connection Between TB in Children and Stunting?
Being the most common chronic disease in Indonesia, TB is closely linked to stunting in children. This is because one of the frequent symptoms in children with TB is weight loss. If this weight issue is not addressed, it can lead to nutritional problems, including an increased risk of stunting.
Dr. Meta emphasizes that a child having difficulty eating is not normal, especially if it persists for a long time, such as two months.
This means that if a child refuses to eat, their weight will not increase, and it’s advisable for parents to take them to a doctor to assess their nutritional status and determine the cause.
In addition to the symptoms mentioned above, other signs to watch out for include prolonged recurrent fever and diarrhea.
The type of cough in a child infected with TB is also different from a cough caused by allergies.
A child with TB will cough continuously, whether in the morning, afternoon, or night.
In contrast, an allergy-related cough often worsens only at certain times, such as only at night or in the morning.
How to Know if a Child Has TB?
The way to determine if a child has TB is by observing their symptoms. If your little one shows any signs or symptoms of TB, see a doctor immediately for further examination.
Typically, the doctor will ask about the child’s symptoms, health history, and family medical history during the check-up.
The doctor will also perform several physical examinations, including TB skin or blood tests.
For a skin test, a small amount of testing material is injected into the top layer of the skin. If a bump of a certain size develops within 2–3 days, the test may be positive for TB infection.
For a TB blood test, a small blood sample is taken from the child’s arm or hand, and the results are available after a few days.
All children with a positive TB test, TB symptoms, or a history of contact with someone with contagious TB should undergo a medical evaluation.
Medical evaluation for TB includes chest X-rays and physical examinations (sputum tests, biopsies of abnormal glands or other body tissues) and must be done before starting treatment for latent TB infection.
TB skin or blood tests are recommended for children who:
- May have been exposed to TB in the last 5 years
- Have X-ray results suggestive of TB
- Show TB symptoms
- Live in or have recently returned from countries where TB is common
URMC also explains that annual TB skin or blood tests should be done for children who:
- Have HIV
- Are in detention facilities
A child exposed to a high-risk person should be tested every 2–3 years.
How to Treat TB in Children?
Once a doctor diagnoses your child with TB, take the following steps to support their care and recovery:
- Gather Information
Find out who transmitted TB to the child. “TB contact is not always someone in the household; it can also be people from the outside environment who are not seen daily, but it is important to know where the child got infected. Once medication is prescribed, ensure it is taken every day to prevent interruption and resistance,” says Dr. Meta.
Seek reliable sources, such as pediatric TB specialists or trusted healthcare facilities, for guidance and treatment. Discuss risks, benefits, and potential side effects of all medications the child will take.
- Medication
It is crucial that children or anyone treated for latent TB infection or TB disease take the medication exactly as prescribed.
In some cases, the child may need hospitalization depending on the type of TB and their condition.
Latent TB Infection
There are several medication options for children with latent TB infection.
Children over 2 years old can be treated with isoniazid-rifapentine once a week for 12 weeks, or daily medications such as rifampin for 4 months or isoniazid for 9 months.
This treatment is intended to prevent the development of active TB.
Both regimens are acceptable, and doctors usually prescribe the shorter regimen for easier adherence.
Active TB (TB disease)
For active TB, treatment involves taking multiple anti-TB medications for 4, 6, 9 months, or longer, depending on the doctor’s prescribed regimen.
The CDC does not recommend a 4-month rifapentine-moxifloxacin TB regimen for children under 12 years old or weighing less than 40 kilograms.
Ensure your child finishes the full course of medication to prevent recurrence.
If medication is not taken correctly, surviving bacteria can become resistant.
Drug-resistant TB is harder and more expensive to treat, with treatment lasting 18–24 months.
How to Prevent TB in Children
So again, parents, TB in children is a preventable and curable disease. Protect your child from TB bacteria by following these steps:
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BCG Vaccine
One way to prevent children from contracting TB is, of course, by giving the BCG (Bacille Calmette-Guérin) vaccine.
This type of vaccine specifically stimulates the formation of antibodies against TB bacteria, making it an important preventive measure.
The BCG vaccine is used in many countries to prevent TB in children, except in the United States, due to the low risk of TB infection and variable vaccine effectiveness.
BCG vaccination should only be considered for selected individuals who meet specific criteria and after consulting a TB doctor.
“The BCG vaccine contains weakened Mycobacterium Bovis bacteria. BCG provides protection against severe tuberculosis and TB-related brain inflammation. However, BCG is not fully effective in preventing primary TB infection. So, it is still possible for a child to develop TB even after receiving the BCG vaccine,” explains Dr. Meta.
2. Ensure Proper Nutrition for Children
Another important aspect to consider regarding TB in children is ensuring they receive adequate nutrition.
3. Complete the Treatment
Dr. Meta explains that the effectiveness of TB treatment can be assessed by the child’s weight gain, improved appetite, and reduction of clinical symptoms. Usually, these improvements can be observed 1–2 months after starting treatment.
That concludes the explanation about TB in children. We hope this article is helpful for you, parents!
Originally published on theAsianparent Indonesia
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