The presentation of TB in children may be very non-specific, particularly in younger children who are presenting with symptoms such as fever and weight loss. Younger children are at risk of TB meningitis, which can result in severe disease.
Taking a history should consider the following points:
- Any symptoms of cough, fever, weight loss, abdominal symptoms?
- Any close contact with adults who have TB (typically family members or other adults in the household)?
- Any underlying health conditions?
- Have they had a BCG vaccination?
Investigations for evidence of TB should be determined by the child’s age (less than or more than 11 years) and whether they have any symptoms suggestive of TB;
- if the child is less than 2 without symptoms, they should have TST test and a chest x-ray if the TST is positive
- if the child is between 2-11 without symptoms, they should have an IGRA blood test and chest x-ray if the IGRA is positive
- if a child is more than 11 years or has symptoms of TB, they should have an IGRA blood test and chest x-ray
If it is suspected that they child has TB disease, every effort should be made to get a microbiology sample to confirm the diagnosis.
Following these investigations, people will be divided into four cohorts which will guide the management (see guideline linked below).