The government never tires of educating the public, especially parents, about how to prevent stunting. This is also related to tuberculosis (TB), commonly known as TBC in children, which carries a risk of causing stunted growth.
To understand the connection between stunting and TBC in children, here is the explanation.
What Is TBC in Children?
According to the University of Rochester Medical Center (URMC), tuberculosis (TB) is a persistent chronic infection caused by bacteria that usually infect the lungs, but other organs such as the kidneys, spine, or brain can also be affected.
This means the disease should not be taken lightly.
How Do Children Contract TBC?
TB most commonly spreads through droplets inhaled or dispersed in the air via coughing or sneezing. A child can be infected with TB bacteria in several ways:
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.
Latent TB Infection: This happens when a child has TB bacteria in their body but does not show symptoms. The child’s immune system keeps the TB bacteria inactive. For most people infected, 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.
TB Disease: This is when a child shows signs and symptoms of an active infection. The child may have positive or negative skin or blood tests, and examinations confirm active TB in the lungs or elsewhere in the body. If the infection is in the lungs and left untreated, the child can spread the disease.
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 account for about 11% of all TB cases globally.
This means that 1.1 million children and young adolescents under 15 fall ill with TB each year, and more than 225,000 of them die.
What Causes TBC in Children?
Tuberculosis is caused by bacteria, most commonly by 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 touched by a person with TB.
Which Children Are at Risk of Contracting TBC?
Any child can develop TB after exposure, and the risk increases if they:
- Live with someone who has TB
- Are homeless
- Come from countries with high TB prevalence
- Have weakened immune systems, including those with diabetes, HIV, or taking medications that suppress immunity
Compared to older children, younger or smaller children are more likely to develop TB through their bloodstream, which can lead to complications such as TB meningitis or disseminated TB.
The Centers for Disease Control and Prevention (CDC) explains that people with TB in the lungs or throat can spread the bacteria to those they spend daily time with.
However, children are less likely to transmit TB bacteria to others. This is because the form of TB commonly seen in children is generally less contagious than the form seen in adults.
What Are the Symptoms of TBC in Children?
Symptoms of TB can vary slightly depending on the child’s age. The most common active TB symptoms in young children include:
- Fever
- Weight loss
- Poor growth
- Cough
- Swollen lymph nodes (some may start leaking fluid through the skin)
- Chills
For older children, the most common active TB symptoms include:
- Cough lasting more than 3 weeks
- Chest pain
- Blood in sputum
- Severe fatigue
- Swollen lymph nodes (some may start leaking fluid through the skin)
- Weight loss
- Loss of appetite
- Fever
- Night sweats
- Chills
Careful observation shows that these TB symptoms are very common and may resemble other illnesses.
To ensure your child is not infected with TB, it is best to consult a doctor for an accurate diagnosis.
“Believe it or not, after further examination, many children are found to have tuberculosis infection,” says pediatric specialist Dr. Meta Herdiana Hanindita, Sp.A(K).
What Is the Link Between TBC in Children and Stunting?
Being the most common chronic disease in Indonesia, TB is closely linked to stunting in children. One reason is that a common symptom of TB in children is weight loss. If this condition is not addressed, it can negatively affect a child’s nutritional status, increasing the risk of stunting.
Dr. Meta emphasizes that a child’s difficulty eating is not normal, especially if it persists for a long period, such as two months.
This means that if a child refuses to eat, their weight will not increase, and it is advisable for parents to take them to a doctor to assess their nutritional status and determine the cause.
In addition to the symptoms mentioned, other signs to watch out for include prolonged recurring fever and diarrhea.
The type of cough in a child infected with TB is also different from a child with allergies.
A child with TB will cough continuously—morning, afternoon, or night.
Allergic coughs, on the other hand, often worsen at specific times, such as only at night or only in the morning.
How to Determine if a Child Has TB
The way to identify TB in children is by observing symptoms. If your child shows signs or symptoms of TB, consult a doctor for further examination.
Doctors will usually ask about symptoms, the child’s medical history, and family health history.
They will also perform physical examinations and may conduct skin or blood tests for TB.
In a skin test, a small amount of test material is injected into the top layer of skin. If a certain-sized bump develops within 2–3 days, the test may be positive for TB infection.
For a TB blood test, a small sample of blood is taken from the child’s arm or hand, with results available a few days later.
All children who test positive for TB infection, show TB symptoms, or have 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, biopsy 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
- Show chest X-ray results suggestive of TB
- Exhibit TB symptoms
- Live in or recently returned from countries where TB is common
URMC also recommends annual TB skin or blood testing for children who:
- Are HIV-positive
- Are in detention facilities
Children exposed to high-risk individuals 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 help care for and treat them:
1. Gather Information
Find out who transmitted TB to the child. “TB contact is not always a household member; it could be someone outside the home, and not necessarily someone you see every day, but it must be identified. After receiving medication, ensure it is taken daily to prevent interruptions and resistance,” says Dr. Meta.
Seek reliable sources such as pediatric TB specialists or trusted healthcare facilities to get accurate information and treatment. Discuss the risks, benefits, and possible side effects of all prescribed medications.
2. Medication
It is essential that children or anyone treated for latent TB infection or TB disease take the medication exactly as prescribed.
In some cases, hospitalization may be required depending on the type of TB and the patient’s condition.
Latent TB Infection
Several treatment options exist for children with latent TB.
- Children over 2 years old can take isoniazid-rifapentine once a week for 12 weeks or daily medications such as rifampicin for 4 months or isoniazid for 9 months.
- This treatment aims to prevent the development of active TB.
- Both regimens are acceptable, and doctors usually prescribe the shorter, more convenient option for the child.
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 the rifapentine-moxifloxacin 4-month TB regimen for children under 12 years old or weighing less than 40 kilograms.
Ensure the child completes the full course of medication to prevent recurrence.
Improper medication intake may result in surviving bacteria developing resistance.
Drug-resistant TB is harder and more expensive to treat, with treatment lasting up to 18–24 months.
How to Prevent TB in Children
Once again, TB in children is a preventable and treatable disease. To protect your child from TB bacteria, follow these preventive steps:
1. BCG Vaccination
One way to prevent children from contracting TB is, of course, through BCG (Bacille Calmette-Guérin) vaccination.
This type of vaccine specifically stimulates the production of antibodies against the 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 certain criteria and after consulting a TB specialist.
“BCG contains weakened Mycobacterium bovis bacteria. It provides protection against severe tuberculosis and TB-related brain inflammation. However, the BCG vaccine is not fully effective in preventing primary TB infection, so a child can still develop TB even after being immunized,” explains Dr. Meta.
2. Ensure Proper Nutrition for the Child
Another important aspect in managing TB in children is ensuring they receive proper nutrition.
3. Complete the Full Course of Treatment
Dr. Meta explains that the effectiveness of TB treatment can be evaluated by monitoring improvements in the child’s weight, appetite, and reduction of clinical symptoms. Typically, these improvements can be observed 1–2 months after starting treatment.
Originally published on theAsianparent Indonesia
