16.1.6 Follow-up and referral of children with TB
As a health worker, you will need to do all you can to administer the chosen treatment and ensure that patients adhere to what they have been told to do. Many children with TB can be managed on an out-patient basis. However, some conditions, such as TB meningitis and other types of EPTB where the infection has spread to organs of the body other than the lung, may require hospitalisation, usually for the first two months of anti-TB treatment. If you find cases where children have respiratory distress, TB involving the spinal cord or they develop severe side effects, they should also be referred to a hospital.
At a minimum, follow-up should include an assessment of symptoms, an evaluation of adherence, an inquiry about any adverse events or side-effects, and the weight of the child should be measured. If the child is losing or gaining weight, they should be referred, because it may be necessary to adjust their medication. As with adult patients, children who were smear-positive for TB at the beginning of treatment should be referred for follow-up sputum smear microscopy at two months, five months, six months and eight months. A child who is not responding to TB treatment should also be referred for further assessment and management.