Tetanus in Children

Tetanus is an acute, sometimes fatal, disease of the central nervous system, caused by the toxin of the tetanus bacterium, which usually enters the body through an open wound. Tetanus bacteria live in soil and manure, but also can be found in the human intestine, animal saliva, and other places:

• Tetanus occurs more often in warmer climates or during the warmer months.

• Tetanus is very uncommon in the U.S. due to widespread immunization.

Tetanus is not a contagious illness. It occurs in individuals who have had a skin or deep tissue wound or puncture. It is also seen in the umbilical stump of infants in underdeveloped countries. This occurs in places where immunization to tetanus is not widespread and women may not know how to properly care for the stump after the baby is born. After being exposed to tetanus, it may take from three to 21 days to develop any symptoms. In infants, symptoms may take from three days to two weeks to develop.

The following are the most common symptoms of tetanus. However, each individual may experience symptoms differently. Symptoms may include:

• Stiffness of the jaw (also called lockjaw)

• Stiffness of the abdominal and back muscles

• Contraction of the facial muscles

• Convulsions

• Fast pulse

• Fever

• Sweating

• Painful muscle spasms near the wound area (if these affect the larynx or chest wall, they may cause asphyxiation)

• Difficulty swallowing

The symptoms of tetanus may resemble other medical conditions. Always consult your child's doctor for a diagnosis.

Symptoms usually confirm the diagnosis of tetanus.

Specific treatment for tetanus will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment for tetanus (or to reduce the risk of tetanus after an injury) may include:

• Thorough cleaning of the wound

• A course of tetanus antitoxin injections

• A tracheostomy (a breathing tube inserted surgically in the windpipe) in severe cases with respiratory problems

• Medications to control spasms

The CDC recommends that children need five DTaP shots. A DTaP shot is a combination vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. The first three shots are given at 2, 4, and 6 months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth is given when a child enters school at 4 to 6 years of age. At regular checkups for 11- or 12-year-olds, a preteen should get a dose of Tdap. The Tdap booster also contains tetanus, diphtheria, and pertussis. If an adult did not get a Tdap as a preteen or teen, then he or she should get a dose of Tdap instead of the Td booster. Adults should then get a Td booster every 10 years, but it can be given before the 10-year mark. Always consult your doctor for advice.

Learn more about tetanus and the tetanus vaccine at CHOP's Vaccine Education Center.