Typhoid in children: recognising it and treating it properly

Recognising it

The classic pattern is a fever that climbs step by step over several days rather than spiking and falling — often reaching 39-40°C by the end of the first week and staying there.

With it: headache, tiredness, poor appetite, abdominal pain, and either constipation or diarrhoea. Children may look listless and uninterested. A faint rash of rose-coloured spots appears in some cases.

It spreads through contaminated food and water, which is why cases rise in the monsoon and after eating out. It is not spread through the air.

Any fever lasting more than three days in an Indian child deserves a doctor and blood tests rather than another day of paracetamol.

Tests, and the Widal problem

Blood culture is the reliable test, and it is most useful in the first week before antibiotics are started. A stool or bone marrow culture is used in some situations.

The Widal test, which is what most families are offered in India, is unreliable — it produces false positives in people previously exposed or vaccinated, and false negatives early in the illness. Many children are treated for typhoid on a Widal result alone when they have something else entirely.

Ask your doctor whether a blood culture can be done, particularly before antibiotics are started. It changes the diagnosis and the choice of antibiotic.

Treatment, and finishing the course

Typhoid needs prescribed antibiotics, and the choice depends on local resistance patterns — drug-resistant typhoid is a growing problem in South Asia, which is another reason culture results matter.

The fever takes several days to settle even on the right antibiotic. Families frequently stop the medicine when the child looks better on day three or four, and that is exactly how relapse and resistance happen. Finish the full course as prescribed.

Supportive care: plenty of fluids, soft easily digested food, rest, and paracetamol for fever. Do not give the child aspirin or repeated ibuprofen without medical advice.

Prevention: boiled or filtered water, freshly cooked hot food, no street food or cut fruit for young children, handwashing, and the typhoid conjugate vaccine, which is on most private schedules in India from around nine months to two years with a booster. It is worth taking.

When to see a doctor

See a doctor for any fever lasting more than three days, and sooner in a child under two or with any chronic illness.

Emergency: severe abdominal pain or a rigid abdomen, vomiting everything, blood in stool or black tarry stools, confusion or extreme drowsiness, a fit, difficulty breathing, or a child who cannot be roused — intestinal perforation and bleeding are the serious complications of untreated typhoid. Call 108.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My child's Widal came back positive. Is it definitely typhoid? — Not necessarily. Discuss a blood culture with the doctor, and ask what else is being considered — dengue, malaria and urinary infection all present with prolonged fever.

Q: Can typhoid come back? — Yes, if the course was not completed, and a small number of people carry the bacteria afterwards. Complete the treatment and attend the follow-up.

Q: Is the typhoid vaccine part of the government schedule? — The typhoid conjugate vaccine has been introduced in some state programmes and is on most private schedules; it is not universally in the national schedule. Ask your paediatrician.

Q: Should the whole family be tested? — Not routinely. If several household members are unwell, or if someone in the family handles food commercially, tell the doctor — that changes the advice.