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What is tuberculosis?
Tuberculosis (or TB) is a contagious infection caused by a type of bacteria called Mycobacterium tuberculosis. Most often it infects the lungs, but it can also attack other parts of the body, such as the spine, kidneys, and brain.
Tuberculosis has two stages:
Stage 1: TB infection (or latent TB)
If a baby has a TB infection, he has a small number of TB germs in his body, but his immune system is preventing them from causing symptoms. Someone infected with TB who doesn't have TB disease can't spread the bacteria to others but should be treated to prevent the development of the disease.
Stage 2: TB disease.
If a baby has TB disease, the germs have multiplied and symptoms are more likely. People with TB disease can spread it to others (although babies and young children usually don't).
What are the symptoms of TB in babies?
Symptoms of TB disease in babies and young children can include;
- A persistent fever
- Loss of appetite
- Weight loss
- Night sweats
- A persistent cough
- Heavy and fast breathing
- Swollen glands
These symptoms are common in other illnesses too, so you'll need to take your baby to a health provider to get the correct diagnosis.
What causes TB in a baby?
- Breathing in airborne bacteria: Your baby can get tuberculosis by inhaling bacteria (which fly into the air when a person with TB disease coughs or sneezes). Children usually contract TB from adults, not from other kids. That's because children's mucus secretions rarely contain many of the bacteria, and their cough isn't strong enough to spray the droplets into the air. Also, the forms of TB disease in children are usually less infectious than adult forms.
- Before or during birth: Babies can contract tuberculosis in the womb or during labor if their mothers are infected with the disease. The bacteria can cross the placenta, or the baby can become infected from ingesting inflected birth canal fluid during birth.
How dangerous is TB in babies?
Fortunately, most children with a TB infection don't become ill. However, if they develop TB disease, this is especially dangerous to babies and young children. After a baby inhales TB bacteria, they settle and grow in the lungs. They can then move through the bloodstream to the kidneys, spine, and brain. This spreading is more likely in babies and children than in adults who contract the disease.
How common is tuberculosis in young children?
Once the leading cause of death in the United States, TB is no longer very common here. From the mid-1980s to 1992, the number of cases in this country was on the rise, peaking at more than 26,000. But since then it has dropped to a low of 9,000 cases in 2018, the lowest incidence rate on record. Only 4 percent of those cases were in children under the age of 15.
In parts of Asia and Africa, however, TB is one of the major childhood diseases. One million children per year contract TB, according to World Health Organization estimates, and more than 230,000 of them die from it. Among all age groups, about 10 million new cases were diagnosed in 2018.
Which babies are at risk for TB?
Children are at highest risk for tuberculosis if they:
- Live in a household with an adult who has active TB
- Are homeless, living in a shelter, or with someone who's been in jail
- Have a weak immune system or an immune deficiency disease, such as HIV
- Were born in a country with a high rate of TB
- Have visited a country with widespread TB and had extended contact with people who live there
- Live in communities with poor health care
What should I do if I think my baby has been exposed to TB?
Call your baby's doctor right away if he has been in contact with someone with TB, or you think he has symptoms of it. Babies and young children are at greater risk for developing complications, such as meningitis, from TB. It's vital that your baby see a doctor immediately for diagnosis and treatment.
How is TB diagnosed in infants?
If there's a chance that your baby has TB, the doctor will:
- Do a skin test. In what's called a tuberculin skin test, the doctor injects an extract of TB bacteria into your baby's forearm. Then the doctor will check the tested area after 48 to 72 hours. She'll be looking for a bump; if she sees one she'll examine the size and firmness of it to tell whether or not the test is positive. Sometimes, doctors perform a blood test instead of a skin test, although this is usually used for children over 5 years old.
- Repeat the skin test (or blood test) if necessary. Because it can take two to 12 weeks after a child first becomes infected for the test to be positive, the doctor may want to repeat the test in about three months if it comes back negative.
- Order a chest X-ray if the skin test or blood test is positive. A positive skin or blood test means that your baby is infected with TB, but he may not yet have developed TB disease (or active TB). Your baby will need a chest X-ray to determine whether he has TB disease.
- Examine your baby's cough secretions and stomach contents. The doctor will do this to look for further evidence of bacteria if the X-ray suggests an infection. This will determine which kind of treatment your baby needs.
How is TB treated in babies?
Treatment depends on the stage of the illness;
- Latent TB infection: If your baby is infected but has not yet developed the disease, he'll need to take antibiotics daily for three to nine months to prevent the disease from developing.
- Active TB disease: If your baby has TB disease, he'll probably take three or four medications for at least six months, depending on how serious the disease is. (Doctors recommend that a baby take several medications at once in case the bacteria are resistant to any of them.) He'll also need regular checkups to see how the treatment is progressing and in case the drugs have side effects.
Though your baby will likely feel better and show signs of improvement after a few weeks of medication, it's crucial that he take his entire course of medicine. If he doesn't, the disease may come back in a much more drug-resistant form.
How can tuberculosis be prevented?
If you live in the United States, your child's risk of getting TB are low. However, you can further reduce the risk of getting infected by:
- Avoiding contact with people who have TB, including while travelling abroad.
- Maintaining good living standards.
- Washing hands frequently
- Sneezing and coughing into a tissue or elbow, not hands
- Not sharing towels, eating utensils and drinking glasses
Should my baby receive the TB vaccine?
Probably not. TB vaccines are not routinely given in the United States because:
- Doctors aren't sure that it's effective
- There's a low incidence of the disease
- Getting the shot may interfere with the results of the tuberculin skin test. (A baby who has had the vaccine may have a positive skin test.)
In countries where TB is common, though, babies and small children are given the vaccine.