Tuberculosis in

Children

KEY POINTS

 There are special considerations for

testing and treating inactive TB (also
known as latent TB infection) and active
TB disease in children.
 Once infected with tuberculosis (TB)
germs, children, especially children
younger than 5 years of age, are more
likely to get sick with active TB disease.

Overview
Tuberculosis (TB) is caused by a bacterium
(or germ) called Mycobacterium
tuberculosis.

TB usually affects the lungs. TB can also

affect other parts of the body, such as the
brain, the kidneys, or the spine. TB can also
affect multiple parts of the body at the
same time. For example, TB can affect both
the lungs and lymph nodes.

Not everyone infected with TB germs

becomes sick. As a result, two TB-related
conditions exist: inactive TB (or latent TB
infection) and active TB disease.

Inactive TB

TB germs can live in the body without

making you sick. This is called inactive TB,
or latent TB infection. Children with inactive
TB are infected with TB germs, but they do
not have active TB disease. They do not
feel sick, do not have any symptoms of TB
disease, and cannot spread TB to others.

Children diagnosed with inactive TB can

take medicine to prevent the development
of TB disease.

Keep Reading:About Inactive

Tuberculosis

Active TB disease

TB germs become active if the immune

system can't stop them from growing.
When TB germs are active (multiplying in
your body), this is called active TB
disease. Children with active TB disease
feel sick. They may also be able to spread
the germs to people they spend time with
every day.

Keep Reading:About Active Tuberculosis

Disease
Once infected with TB germs, children,
especially children younger than 5 years of
age, are more likely to get sick with active
TB disease and to get sick more quickly
than adults.
Infants and young children are more likely
than older children and adults to develop
severe forms of TB disease [such as TB
disease of the brain (TB meningitis) or
miliary TB disease (TB disease in multiple
parts of the body)].

Without treatment, TB disease can be fatal.

Children diagnosed with active TB disease
can take medicine to treat the disease.

Symptoms
Symptoms of active TB disease in children
include:

 Cough
 Feelings of sickness or weakness,
lethargy, or reduced playfulness
 Weight loss or failure to thrive
 Fever
 Night sweats

The most common form of TB disease

occurs in the lungs, but TB disease can
affect other parts of the body as well.
Symptoms of TB disease in other parts of
the body depend on the area affected. For
example, TB disease of the brain (also
known as TB meningitis) can cause
symptoms such as sleepiness, headache,
irritability, and seizures or convulsions.

Keep Reading:Signs and Symptoms of

Tuberculosis

Risk factors
Anyone can get TB. Because of their age,
infants and young children with inactive TB
have been infected with TB germs recently
and are at higher risk for developing active
TB disease.
Children also have a higher risk for TB if
they:

 Live with family members or other adults

who have risk factors for TB
 Were born in or frequently travel to
countries where TB is common, including
some countries in Asia, Africa, and Latin
America
 Live or used to live in large group
settings where TB is more common, such
as homeless shelters, prisons, or jails
 Recently spent time with someone who
has active TB disease
 Have a weaker immune system because
of certain medications or health
conditions such as diabetes, cancer,
and HIV

Keep Reading:Tuberculosis Risk Factors

How it spreads
TB is spread through the air from one
person to another. The TB germs are put
into the air when a person with active TB
disease of the lungs or throat coughs,
speaks, or sings.

These germs can stay in the air for several

hours, depending on the environment. TB
germs are more likely to spread in indoor
areas or other places with poor air
circulation (such as a closed vehicle) than
in outdoor areas. Children who breathe in
the air become infected with TB.

Young children are less likely to spread TB

germs to others. Health care providers and
public health workers will help decide if
someone who has been around a child with
active TB disease should get tested for TB.

Keep Reading:Tuberculosis: Causes and

How It Spreads
Prevention
Children diagnosed with inactive TB can
take medicine that can help prevent active
TB disease from developing.

Keep Reading:Preventing Tuberculosis

Quick facts
In 2023, there were 466 cases of TB
disease (4.8% of all U.S. TB cases) among
children aged 14 years or younger in the
United States.

Testing and diagnosis

All children with a positive test result for TB
infection (TB blood test or TB skin test),
symptoms of TB disease, or who have spent
time with a person with active TB disease
should receive a medical evaluation for TB.

A medical evaluation for TB disease

includes:

1. Medical history
2. Physical examination
3. Test for TB infection (TB blood test or TB
skin test)
4. Chest x-ray
5. Laboratory tests to see if TB germs are
present (sputum smear and culture)
6. Laboratory tests for drug resistance

Testing for TB infection

There are two types of tests for TB

infection: the TB blood test and the TB skin
test.

Current CDC guidelines recommend the TB

skin test as the method of testing for
children younger than 5 years of age, while
noting that some experts use TB blood tests
in younger children. Health care providers
may choose to consult the American
Academy of Pediatrics (AAP) guidance on
the use of TB blood tests in children.

TB Blood Test

TB blood tests (also called interferon-

gamma release assays or IGRAs) use a
blood sample to find out if someone is
infected with TB germs. The tests measure
how the immune system reacts when a
small amount of blood is mixed with TB
proteins.

If a child is 5 years of age or older and has

ever received a vaccine for TB, their health
care provider should recommend the TB
blood test. Unlike the TB skin test, TB blood
tests are not affected by the TB vaccine
(BCG vaccine).

TB Skin Test

For the TB skin test, a health care provider

uses a small needle to put some testing
material under the skin. The child will need
to return to their health care provider in
two to three days to see if there is a
reaction.

Understanding TB Blood Test or TB

Skin Test Results

A positive test result for TB

infection means a child has TB germs in
their body. A health care provider will do
other tests to determine if a child has
inactive TB or active TB disease. These
tests may include a chest x-ray, and a test
of the sputum (phlegm) a child coughs up.

A negative test result for TB

infection means inactive TB or active TB
disease is unlikely, but a health care
provider may do more tests, especially if a
child:

 Has symptoms of active TB disease, like

coughing, chest pain, fever, weight loss,
or tiredness.
 Has HIV.
 Was recently exposed to TB germs.

A negative test result for TB infection

does not exclude TB infection, and if TB
disease is a possibility, health care
providers should proceed with medical
evaluation for TB disease.

Chest x-ray

Health care providers may use a chest x-

ray to look for signs of TB disease in a
child's lungs.

Laboratory tests

A health care provider may collect samples

from a child. A common sample is a sputum
(phlegm) specimen to test for TB of the
lungs.

Children may be unable to cough up

sputum. A health care provider can insert a
tube through the mouth or nose and into
the stomach to get sputum to test. This
procedure is called a gastric aspiration.

Health care providers may also collect a

urine sample, take tissue samples, or do
other tests. These tests can find TB germs
that may be outside the lungs.

The laboratory will do tests, such as a

smear test and a culture test to see
whether there are TB germs in the sample.
If the laboratory finds TB germs in the
sample, they will also do tests to see which
TB medicines can kill the TB germs.
Diagnosis

Inactive TB

If a child has a positive TB blood test or TB

skin test result, but their health care
provider does not find evidence of TB
disease after a medical evaluation, they
may be diagnosed with inactive TB. Health
care providers must make sure the child
does not have active TB disease before
beginning treatment for inactive TB.

Active TB disease

Confirming the diagnosis of TB disease in

children with a laboratory test can be
challenging because:

 It is difficult to collect sputum (phlegm)

specimens from infants and young
children; and
 Children are more likely to have TB
disease caused by a smaller number of
TB germs in the lungs. This means the
laboratory tests used to find TB germs in
sputum are less likely to have a positive
result.

Some children are diagnosed with TB

disease even when the laboratory does not
confirm that TB germs are present but
other factors point to TB disease:

 Symptoms of TB disease
 Positive TB blood test or TB skin test
result
 Abnormal chest x-ray
 Time spent with person with infectious
TB disease.

Treatment and recovery

There are several treatments available, and
health care providers will consider a child's
age, weight, and other factors when
prescribing treatment.

Keep Reading:TB Treatment for Children

Treating inactive TB in children

Treatment is recommended for children

with inactive TB to prevent them from
developing TB disease. Depending on the
TB treatment regimen a health care
provider prescribes, treatment for inactive
TB may take three months, four months, or
longer.

Treating active TB disease in

children

Children with active TB disease will need to

take several different TB medicines. This is
because there are many TB germs to be
killed. Taking several TB medicines will do a
better job of killing all the TB germs and
prevent them from becoming resistant to
the medicines.

Depending on the TB treatment regimen a

health care provider prescribes, treatment
for TB disease may take four months, six
months, or longer.

Importance of completing
treatment

It is very important that children or anyone

being treated for inactive TB or active TB
disease finish the medicine and take the
drugs exactly as instructed.

If a child stops taking the TB medicines

before completion, the child can become
sick again. If medicines are taken
incorrectly, the TB germs that are still alive
may become resistant to those drugs. TB
that is resistant to drugs is harder and more
costly to treat, and treatment can take a
long time.

Directly Observed Therapy (DOT)

The best way to take medicines for active

TB disease (and in some cases, inactive TB)
is by receiving directly observed therapy
(DOT). Through DOT, a health care worker
will visit the child every day or several
times a week. These visits may be in-
person or virtual (through a smartphone,
tablet, or computer). The health care
worker will watch the child take their TB
medicines and make sure that the TB
medicines are working as they should.

Vaccines
Bacille Calmette-Guérin (BCG) is a vaccine
for TB disease. The vaccine is not generally
used in the United States. It is given to
infants and small children in countries
where TB is common. It protects children
from getting severe forms of active TB
disease, such as TB meningitis (TB disease
of the brain).

The vaccine can cause a false positive TB

skin test reaction. TB blood tests are the
preferred tests for people 5 years of age
and older who have received the BCG TB
vaccine. Tell your child's health care
provider if they have received the BCG TB
vaccine.

Resources
What You Need to Know About
Tuberculosis Fact Sheet
Download
Questions and Answers About
Tuberculosis Booklet
Download
Tuberculosis Personal Stories
Intercountry (International) Adoption:
Tuberculosis

ON THIS PAGE

 Overview
 Symptoms
 Risk factors
 How it spreads
 Prevention
 Quick facts
 Testing and diagnosis
 Treatment and recovery
 Vaccines
 Resources

Tuberculosis in
Children

KEY POINTS

 There are special considerations for

testing and treating inactive TB (also
known as latent TB infection) and active
TB disease in children.
 Once infected with tuberculosis (TB)
germs, children, especially children
younger than 5 years of age, are more
likely to get sick with active TB disease.
Overview
Tuberculosis (TB) is caused by a bacterium
(or germ) called Mycobacterium
tuberculosis.

TB usually affects the lungs. TB can also

affect other parts of the body, such as the
brain, the kidneys, or the spine. TB can also
affect multiple parts of the body at the
same time. For example, TB can affect both
the lungs and lymph nodes.

Not everyone infected with TB germs

becomes sick. As a result, two TB-related
conditions exist: inactive TB (or latent TB
infection) and active TB disease.

Inactive TB

TB germs can live in the body without

making you sick. This is called inactive TB,
or latent TB infection. Children with inactive
TB are infected with TB germs, but they do
not have active TB disease. They do not
feel sick, do not have any symptoms of TB
disease, and cannot spread TB to others.

Children diagnosed with inactive TB can

take medicine to prevent the development
of TB disease.

Keep Reading:About Inactive

Tuberculosis

Active TB disease

TB germs become active if the immune

system can't stop them from growing.
When TB germs are active (multiplying in
your body), this is called active TB
disease. Children with active TB disease
feel sick. They may also be able to spread
the germs to people they spend time with
every day.

Keep Reading:About Active Tuberculosis

Disease
Once infected with TB germs, children,
especially children younger than 5 years of
age, are more likely to get sick with active
TB disease and to get sick more quickly
than adults.

Infants and young children are more likely

than older children and adults to develop
severe forms of TB disease [such as TB
disease of the brain (TB meningitis) or
miliary TB disease (TB disease in multiple
parts of the body)].

Without treatment, TB disease can be fatal.

Children diagnosed with active TB disease
can take medicine to treat the disease.

Symptoms
Symptoms of active TB disease in children
include:
  Cough
 Feelings of sickness or weakness,
lethargy, or reduced playfulness
 Weight loss or failure to thrive
 Fever
 Night sweats

The most common form of TB disease

occurs in the lungs, but TB disease can
affect other parts of the body as well.
Symptoms of TB disease in other parts of
the body depend on the area affected. For
example, TB disease of the brain (also
known as TB meningitis) can cause
symptoms such as sleepiness, headache,
irritability, and seizures or convulsions.

Keep Reading:Signs and Symptoms of

Tuberculosis

Risk factors
Anyone can get TB. Because of their age,
infants and young children with inactive TB
have been infected with TB germs recently
and are at higher risk for developing active
TB disease.

Children also have a higher risk for TB if

they:

 Live with family members or other adults

who have risk factors for TB
 Were born in or frequently travel to
countries where TB is common, including
some countries in Asia, Africa, and Latin
America
 Live or used to live in large group
settings where TB is more common, such
as homeless shelters, prisons, or jails
 Recently spent time with someone who
has active TB disease
 Have a weaker immune system because
of certain medications or health
conditions such as diabetes, cancer,
and HIV
Keep Reading:Tuberculosis Risk Factors

How it spreads
TB is spread through the air from one
person to another. The TB germs are put
into the air when a person with active TB
disease of the lungs or throat coughs,
speaks, or sings.

These germs can stay in the air for several

hours, depending on the environment. TB
germs are more likely to spread in indoor
areas or other places with poor air
circulation (such as a closed vehicle) than
in outdoor areas. Children who breathe in
the air become infected with TB.

Young children are less likely to spread TB

germs to others. Health care providers and
public health workers will help decide if
someone who has been around a child with
active TB disease should get tested for TB.

Keep Reading:Tuberculosis: Causes and

How It Spreads

Prevention
Children diagnosed with inactive TB can
take medicine that can help prevent active
TB disease from developing.

Keep Reading:Preventing Tuberculosis

Quick facts
In 2023, there were 466 cases of TB
disease (4.8% of all U.S. TB cases) among
children aged 14 years or younger in the
United States.

Testing and diagnosis

All children with a positive test result for TB
infection (TB blood test or TB skin test),
symptoms of TB disease, or who have spent
time with a person with active TB disease
should receive a medical evaluation for TB.

A medical evaluation for TB disease

includes:

1. Medical history
2. Physical examination
3. Test for TB infection (TB blood test or TB
skin test)
4. Chest x-ray
5. Laboratory tests to see if TB germs are
present (sputum smear and culture)
6. Laboratory tests for drug resistance

Testing for TB infection

There are two types of tests for TB

infection: the TB blood test and the TB skin
test.

Current CDC guidelines recommend the TB

skin test as the method of testing for
children younger than 5 years of age, while
noting that some experts use TB blood tests
in younger children. Health care providers
may choose to consult the American
Academy of Pediatrics (AAP) guidance on
the use of TB blood tests in children.

TB Blood Test

TB blood tests (also called interferon-

gamma release assays or IGRAs) use a
blood sample to find out if someone is
infected with TB germs. The tests measure
how the immune system reacts when a
small amount of blood is mixed with TB
proteins.

If a child is 5 years of age or older and has

ever received a vaccine for TB, their health
care provider should recommend the TB
blood test. Unlike the TB skin test, TB blood
tests are not affected by the TB vaccine
(BCG vaccine).

TB Skin Test

For the TB skin test, a health care provider

uses a small needle to put some testing
material under the skin. The child will need
to return to their health care provider in
two to three days to see if there is a
reaction.

Understanding TB Blood Test or TB

Skin Test Results

A positive test result for TB

infection means a child has TB germs in
their body. A health care provider will do
other tests to determine if a child has
inactive TB or active TB disease. These
tests may include a chest x-ray, and a test
of the sputum (phlegm) a child coughs up.

A negative test result for TB

infection means inactive TB or active TB
disease is unlikely, but a health care
provider may do more tests, especially if a
child:

 Has symptoms of active TB disease, like

coughing, chest pain, fever, weight loss,
or tiredness.
 Has HIV.
 Was recently exposed to TB germs.

A negative test result for TB infection

does not exclude TB infection, and if TB
disease is a possibility, health care
providers should proceed with medical
evaluation for TB disease.

Chest x-ray
Health care providers may use a chest x-
ray to look for signs of TB disease in a
child's lungs.

Laboratory tests

A health care provider may collect samples

from a child. A common sample is a sputum
(phlegm) specimen to test for TB of the
lungs.

Children may be unable to cough up

sputum. A health care provider can insert a
tube through the mouth or nose and into
the stomach to get sputum to test. This
procedure is called a gastric aspiration.

Health care providers may also collect a

urine sample, take tissue samples, or do
other tests. These tests can find TB germs
that may be outside the lungs.

The laboratory will do tests, such as a

smear test and a culture test to see
whether there are TB germs in the sample.
If the laboratory finds TB germs in the
sample, they will also do tests to see which
TB medicines can kill the TB germs.

Diagnosis

Inactive TB

If a child has a positive TB blood test or TB

skin test result, but their health care
provider does not find evidence of TB
disease after a medical evaluation, they
may be diagnosed with inactive TB. Health
care providers must make sure the child
does not have active TB disease before
beginning treatment for inactive TB.

Active TB disease
Confirming the diagnosis of TB disease in
children with a laboratory test can be
challenging because:

 It is difficult to collect sputum (phlegm)

specimens from infants and young
children; and
 Children are more likely to have TB
disease caused by a smaller number of
TB germs in the lungs. This means the
laboratory tests used to find TB germs in
sputum are less likely to have a positive
result.

Some children are diagnosed with TB

disease even when the laboratory does not
confirm that TB germs are present but
other factors point to TB disease:

 Symptoms of TB disease
 Positive TB blood test or TB skin test
result
 Abnormal chest x-ray
 Time spent with person with infectious
TB disease.

Treatment and recovery

There are several treatments available, and
health care providers will consider a child's
age, weight, and other factors when
prescribing treatment.

Keep Reading:TB Treatment for Children

Treating inactive TB in children

Treatment is recommended for children

with inactive TB to prevent them from
developing TB disease. Depending on the
TB treatment regimen a health care
provider prescribes, treatment for inactive
TB may take three months, four months, or
longer.
Treating active TB disease in
children

Children with active TB disease will need to

take several different TB medicines. This is
because there are many TB germs to be
killed. Taking several TB medicines will do a
better job of killing all the TB germs and
prevent them from becoming resistant to
the medicines.

Depending on the TB treatment regimen a

health care provider prescribes, treatment
for TB disease may take four months, six
months, or longer.

Importance of completing
treatment

It is very important that children or anyone

being treated for inactive TB or active TB
disease finish the medicine and take the
drugs exactly as instructed.

If a child stops taking the TB medicines

before completion, the child can become
sick again. If medicines are taken
incorrectly, the TB germs that are still alive
may become resistant to those drugs. TB
that is resistant to drugs is harder and more
costly to treat, and treatment can take a
long time.

Directly Observed Therapy (DOT)

The best way to take medicines for active

TB disease (and in some cases, inactive TB)
is by receiving directly observed therapy
(DOT). Through DOT, a health care worker
will visit the child every day or several
times a week. These visits may be in-
person or virtual (through a smartphone,
tablet, or computer). The health care
worker will watch the child take their TB
medicines and make sure that the TB
medicines are working as they should.

Vaccines
Bacille Calmette-Guérin (BCG) is a vaccine
for TB disease. The vaccine is not generally
used in the United States. It is given to
infants and small children in countries
where TB is common. It protects children
from getting severe forms of active TB
disease, such as TB meningitis (TB disease
of the brain).

The vaccine can cause a false positive TB

skin test reaction. TB blood tests are the
preferred tests for people 5 years of age
and older who have received the BCG TB
vaccine. Tell your child's health care
provider if they have received the BCG TB
vaccine.

Resources
What You Need to Know About
Tuberculosis Fact Sheet
Download
Questions and Answers About
Tuberculosis Booklet
Download
Tuberculosis Personal Stories
Intercountry (International) Adoption:
Tuberculosis

ON THIS PAGE

 Overview
 Symptoms
 Risk factors
 How it spreads
 Prevention
 Quick facts
 Testing and diagnosis
 Treatment and recovery
 Vaccines
 Resources