Typhoid in Kids: Signs, Diagnosis and Pediatric Care

Typhoid is among the deadliest bacterial infections occurring in children. Typhoid is prevalent in conditions where sanitation is poor and getting clean drinking water is impossible.

A weak immune system is the key culprit for typhoid in kids. The typhoid-causing- salmonella is an acid-sensitive bacteria that will perish in the stomach’s acidic environment under normal conditions. But if the acid surroundings are altered when medicines like antacids and antihistamines are taken, and conditions like achlorhydria due to food & beverages, then the salmonella may survive. Which later flourish and cause typhoid.

The infection phase in typhoid has undergone modifications and developments with time, leading to multi-drug resistance to commonly used drugs in treating typhoid infections. The current challenge in dealing with typhoid in kids is mainly due to two reasons: a wide range of variations in symptoms and multi-drug resistance to typhoid.

Fever and rashes are the two main symptoms of typhoid. Stomach ache, headache and constipation are the other symptoms seen in typhoid. Fever in typhoid is typically high and steadily increases with each passing day. Rashes appear as rose-coloured spots in the neck and abdomen region. The diagnostic options for treatment in typhoid include antigen identification, bacterial culture and serological marker.

Typhoid infection can be treated with antibacterials. Following good hygiene and getting the vaccine are the best way to avoid typhoid fever and associated symptoms.

Now that we know the basics of typhoid Let’s proceed to Know about what, how, where, and why of typhoid illness in kids.

What is typhoid fever?

Typhoid fever which is also called enteric fever, occurs due to the bacteria salmonella typhus. It lives inside the human body and passes out through faeces and urine.

The infection gets inside the body when you get into contact with this contaminated food, water or carrier person may accidentally get associated with the infection-laden person; once inside, they multiply inside the stomach and cause stomach pain, diarrhoea, constipation and fever.

Read more: Effect of Seasons Upon Diseases and Their Prevention

How do children get typhoid fever?

Children get typhoid from another typhoid-infected person or food and water contaminated with human faeces containing bacteria. Typhoid also spreads when drinking water is contaminated through sewage water.

Enteric fever mainly affects the stomach region. Typhoid fever is common in babies and young children, especially in places with inadequate water and sanitation.

What are the hallmark signs & symptoms of typhoid in kids?

The symptoms of typhoid in children will be evident after 1-2 weeks of infection or coming in contact with contamination. The symptoms can last up to 4 weeks or longer. The symptoms include

• A fever phase is more than 100 degrees temperature lasting for around five days and with a rise in fever temperature with each passing day
• A general feeling of discomfort, weakness and tiredness
• Pain in the abdominal region
• Cough
• Chills
• Vomiting
• Headaches
• A coating on the tongue( called typhoid tongue)
• Constipation
• Diarrhoea
• Rose or pink coloured rash or spots on neck, chest and stomach ( rare symptom)

Typhoid follows a specific pattern; the temperature rises with the day, reaches a maximum by evening, and drops by morning. But, there are cases which do not follow this pattern too. So do speak to your doctor in case of any questions.

How is typhoid diagnosed in young children/kids?

The diagnosis of typhoid in young children with asking questions enquiring about symptoms (to the child; if they are older enough to communicate or to the parents) to help in diagnosis.

The doctor will also look for clinical signs like a faint heartbeat, swollen liver and spleen.
A blood test/culture is usually required to confirm typhoid symptoms.

The widal test is a standard test for typhoid testing. It is not a specific test but is widely used. The other tests which are used in diagnosis include urine and stool test.

What is the treatment for children affected with typhoid infection?

Antibiotics are the primary medicines for the treatment of typhoid. Complete the entire course of typhoid medication, as taking less than the prescribed dose means the complete bacteria inside the body are not killed. Children will start to feel better as soon as in 2-3 days.

Paracetamol is also indicated, along with antibiotics, in case of fever. If the fever does not go away, call your doctor immediately.

The treatment for typhoid will begin before the laboratory test results are out, as keeping the child without medicine may be dangerous. Once the tests are positive for typhoid, specific antibiotics for adequate time are given.

Always stay in touch with the doctor during the course of treatment and ensure all the instructions given to the child are duly followed.

What kind of diet do I give to my child during typhoid?

Remember that the child may have the usual appetite but must still be fed. Most importantly, give plenty of fluids to the child. Then, give light foods that can be easily digested. Let’s have a quick look at what kinds of foods can be eaten and what foods should be avoided.

Give lots of liquids, and there is a loss of body fluids in the form of fever, sweat, vomiting, and diarrhoea. The body needs more fluids to compensate and run the other bodily functions smoothly.

In the case of breastfed infants, feed them often as much as they want to drink. For the children fed through bottle feeding, let them drink formula milk every half hour.

Your doctor will prescribe ORS solutions to your child. Follow your doctor’s instructions for the frequency and volume of ORS solution to be given.

If the child is old enough, then offer buttermilk, home-made juices, and cow’s milk. If it is a packet of milk, give them low-fat, double-toned pasteurised milk.

Do not give coffee, tea or caffeinated drinks, packaged juices, energy drinks and packed beverages

A) Foods that are good during typhoid

Offer kid’s favourite foods in smaller portions like Khichdi made from moong dal and rice or sabudana, Idly, Poha, steamed or well-cooked vegetables, mashed potatoes, curd, paneer, cheese, home-made soups, and seasonal fruits like banana, apples, watermelon, and grapes.

B) Foods that are not good during typhoid

Foods which may not get digested easily during typhoid and cause flatulence or gas should be avoided. These include:

High-fibre, spicy and fatty foods, sugary foods, junk foods, and raw vegetables which are commonly used for the preparation of salad like cabbage, capsicum, onion, cauliflower, broccoli and seeds like rajma, chickpeas( cholla), Bengal gram (chana) and whole wheat grains like brown rice, oats and quinoa.

Do consult your doctor before making any changes in the diet.

How can I prevent typhoid infection?

As typhoid is common in places with inadequate water supply and poor sanitation. Providing safe drinking water, enough water for sanitation, and, lastly and more importantly, getting a typhoid vaccine helps prevent typhoid infection.

Typhoid conjugate vaccine containing pure VI antigen is given as a single dose in children above 6 months and adults up to 45- 65 years of age.

World Health Organisation(WHO) has recommended two typhoid vaccines since December 2017. They are given as a part of the vaccination programme, especially in typhoid-endemic countries like India.

1) A few preventive measures include

Clean water for all essential activities is vital. Wash the vegetables properly with filtered water. Always drink safe and clean water; in case of not sure, boil & cool the water before drinking. Adults may drink filtered water. Make sure all the baby’s equipment is washed and properly sterilised.

2) Precautions when eating out

Avoid foods which are sold by street vendors, especially during monsoons; flavoured ice drinks and cold foods are more likely to be contaminated with salmonella typhi.

Raw milk or contaminated milk products, ice-creams are thought to be contaminated with typhoid-causing bacteria. Know that food cooked at home is clean, safe and hygienic.

3) Follow hygienic practices

• Always wash your hands with hand wash and water, especially when
• Before eating
• Before cooking
• Before feeding your child
• After using the toilet, cleaning the baby’s stool and changing diapers,
• After handling pets.

Conclusion

Typhoid is a highly infectious disease which quickly spreads through contaminated eatables and infectious individuals as the disease-causing bacteria, i.e. salmonella typhi, gets inside the body, multiplies, and spreads into the body.

Signs & symptoms like fever, abdominal pain and rashes are the identifications of typhoid disease. This is confirmed through various levels of diagnosis; late diagnosis followed by treatment of typhoid has become challenging due to multi-drug resistance and changes in the environment and surroundings. Hence, it makes the situation more complicated.

This whole issue can be controlled through the prevention of typhoid infection. As they can “prevention is the best cure”. Practising safety rules and getting vaccinated are a few things which will stop typhoid spread.

In response to the typhoid spread in October 2017 World Health Organization(WHO), the strategic advisory group of experts on immunisation (SAGE) that advises vaccination to WHO, recommended including the typhoid conjugate vaccine in the routine vaccination programme for children above six months. In 2023 WHO qualified two types of typhoid conjugate vaccine. The conjugate vaccine has longer-lasting immunity and can be given as a single dose.

Apart from decreasing the disease burden in the endemic countries and saving lives. It has also helped reduce the use of antibiotics for treating typhoid infection and reducing resistance to treatment.

References

• Typhoid fever [Internet]. Kidshealth.org. [cited 2023 Jul 12]. Available from: https://kidshealth.org/en/parents/typhoid.html
• Typhoid [Internet]. Who.int. [cited 2023 Jul 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/typhoid
• Devaranavadagi RA, S. S. A study on clinical profile of typhoid fever in children. Int J Contemp Pediatr [Internet]. 2017 [cited 2023 Jul 12];4(3):1067. Available from: https://www.ijpediatrics.com/index.php/ijcp/article/view/835
• Researchgate.net. [cited 2023 Jul 12]. Available from: https://www.researchgate.net/publication/358284134_Typhoid_fever_in_children_A_Review