What is human immunodeficiency virus (HIV)?
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Human immunodeficiency virus (HIV) is an infectious disease, but it is included in this book because unlike many infectious diseases, HIV is a lifelong condition for many children.
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HIV is a blood-borne viral infection that attacks the body’s immune system. Infection with HIV involves the cells responsible for controlling the body’s immune system. Infants and young children usually acquire HIV from their mother when they are born, but with widespread testing and aggressive treatment of infected mothers during their pregnancy, this type of transmission has become much less common.
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HIV is also rarely acquired by contaminated needles or sharp instruments, or through contact of mucous membranes or injured skin with infected substances such as blood or secretions.
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The most common means by which adolescents become HIV-infected is through sexual contact and use of intravenous drugs.
How common is it?
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Approximately 6,100 children and youth who acquired HIV during birth were living in 2006.
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Between 100 and 200 babies are born infected with HIV in the United States each year, despite the availability of HIV testing and treatment.
What are some characteristics of children with HIV?
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Most children with HIV may appear very healthy and be able to participate in all activities. Some children with HIV/AIDS are frequently sick and may require numerous hospitalizations.
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Children with active HIV infection can get
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Diarrhea.
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Swollen lymph nodes.
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Pneumonia and other lung diseases.
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Thrush (a yeast infection on the surfaces of the mouth).
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Babies with HIV may not gain weight well if their disease is not controlled by medication.
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Who is the treatment team?
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Infectious disease specialists are frequently involved in the child’s health care as well as the primary care provider in the medical home.
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Parents/guardians do not have to share information about the HIV status of their children with schools or child care providers, but it is easier to care for children when there is good communication.
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If parents share the HIV status of their child, the information should not be shared with staff without written permission of the parents/guardians. Confidentiality should be respected and the plan for sharing information should be very clear to all.
What adaptations may be needed?
Medications
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It is very important that children with HIV take their medication regularly. The medications may not taste good but can often be flavored. Ask if the medication can be mixed with pudding or applesauce.
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Exposure to varicella (chickenpox) and measles can be particularly dangerous for children with HIV infection. Make sure that all the children enrolled at the program are up to date on their vaccinations to minimize the risk of these infections. All parents should be notified about an exposure to measles or chickenpox but early, personal notification of parents of children with HIV infection (as for any other immune-deficiency disease), if the identity of these children is known, is recommended.
Physical environment
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Children with HIV can participate in all activities that their health permits. It is important to establish good lines of communication before enrollment to discuss all the relevant health-related issues.
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For all children, regardless of HIV status, standard pre cautions should be followed when blood or blood-containing fluids are handled. For blood and blood-containing substances, these are the same precautions described by the Occupational Safety and Health Administration as universal precautions.
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Wear disposable gloves or, if using utility gloves, be sure the utility gloves are sanitized after use.
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Absorb as much of the spill as possible with disposable materials; put the contaminated materials in a plastic bag with a secure tie.
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Clean contaminated surfaces with detergent and water.
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Rinse with water.
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Sanitize the clean surface by wetting the entire surface with a spray application of freshly diluted domestic bleach (¼ cup of bleach in 1 gallon of water equals 1 tablespoon to a quart) and leaving this solution in contact with the surface for at least 2 minutes. Some health authorities recommend using a stronger solution of freshly diluted bleach (1:10) to disinfect surfaces that involved blood because if hepatitis B virus is present, it is more difficult to kill with bleach than other organisms that might be found in blood. HIV is easily deactivated by bleach.
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Dispose of all soiled items in plastic bags with secure ties.
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What should be considered an emergency?
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There are no special emergencies faced by children with HIV that vary from other children.
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Notify parents immediately for exposure to chickenpox or measles.
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Biting of another child or vice versa.
What types of training or policies are advised?
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Standard precautions
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Biting
What are some resources?
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Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition, American Academy of Pediatrics,www.aap.org/bookstore, 888/227-1770 -
Centers for Disease Control and Prevention,www.cdc.gov, 800/CDC-INFO (232-4636)
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Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, standards 3.026, 3.027, 6.033, 6.034, 8.053, and 8.057
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.