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Education Materials > Publications > Improving Patients Adherence to TB Treatment > Adherence by Children and Adolescents

Improving Patient Adherence to Tuberculosis Treatment (1994)

Adherence by Children and Adolescents

Section Topics

Children with TB present specific problems for adherence. However, there is very little information about the rates of adherence among children or methods for improving it. Many children with TB have few or no symptoms of the disease, and many do not experience a dramatic improvement in symptoms when given appropriate treatment. Because of the characteristics of the disease in children, you may have difficulty convincing parents that their children are ill and need treatment and that the treatment needs to be given as prescribed (32).

Strategies for Improving Adherence

To improve adherence among children, work with the parents or caregivers who will administer medications to young children. You cannot assume that parents will give medications to their children as prescribed; some parents are nonadherent (it is difficult to get children to take medicines that taste unpleasant). Every measure to ensure adherence in patients must also be taken to ensure that parents give needed TB medications to their children. Consider additional measures to accommodate the special needs of young children.

  1. Provide anticipatory guidance. Talk with parents about the potential problems they may experience with their children when TB treatment is initiated. Children may

    • resist taking medications
    • have difficulty swallowing pills and capsules, the common form of TB medications
    • experience adverse reactions to the medications

    When parents are aware of the potential problems that can arise during their child's treatment, they are better able to cope with the problems and assist with the treatment.

  2. Give DOT. Consider giving DOT to children with TB when you are unable to ensure that their parents or caregivers are administering the medications as prescribed. Supplement DOT with incentives and enablers (such as coloring books and toys) to encourage cooperation from the child.
  3. Give TB medications in easy-to-take preparations. Rifampin (RIF) can be made into a liquid suspension by the pharmacist. Isoniazid (INH) can also be prepared as a suspension, although its stability varies. INH and pyrazinamide (PZA) pills can be crushed and given with small amounts of food; RIF should be taken on an empty stomach (33).

Adherence by Adolescents

Adolescents may be responsible for taking their own medications, but they are also at high risk for poor adherence. Because of their concerns about the opinions of peers, adolescents may be particularly embarrassed about having to take TB medications. Also, they may not feel threatened by TB and may not take the condition seriously. For these reasons, adolescents are a high priority group for DOT.

Children and adolescents need carefully individualized treatment plans. Be vigilant in monitoring adherence and creative in finding ways to ensure adherence.



Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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