by Amy Buch
September 2006
Every parent wants his or her child to be healthy and safe. When your child is HIV+, there are some extra steps to take to make sure that he or she gets the right care. The good news is that HIV+ children, just like HIV+ adults, are living longer, healthier lives with improved treatments.
HIV is somewhat different in children than in adults. HIV+ children normally have much higher CD4 cell counts than adults, but may also have higher viral loads (the amount of HIV in the blood).
HIV+ children are challenged by the fact that HIV is attacking their developing immune systems. As a result, HIV+ children are more likely to get bacterial infections such as pneumonia or sinusitis (inflammation of the air spaces that open into the nose). HIV+ children also may be more likely to have diarrhea or thrush (white patches in the mouth due to yeast).
Sometimes, the signs of HIV appear on the skin. Warts and molluscum contagiosum (small bumps on the skin), which are common in children and caused by certain viruses, can be more bothersome for HIV+ children.
Recommendations have been made to prevent both HIV+ children and adults from getting opportunistic infections (OIs), diseases that attack the body when the immune system is weak. All HIV+ children up to the age of one are given medicine to prevent pneumocystis carinii pneumonia (PCP, now also called pneumocystis jirovecii), a type of pneumonia that is more likely to affect people with poor immune systems. After the first year, some children will still be given preventative medicine depending on their immune systems.
If an HIV+ child tests positive for exposure to tuberculosis (TB) after a TB skin test, other medicine will be given to keep TB from developing. Depending on the child’s age and immune system, medication might also be given to prevent mycobacterium avium complex (MAC), which is caused by a germ that can affect the lungs or the gut. In some cases, these kinds of preventative medications can be stopped as the immune system becomes stronger.
Vaccinating your child is one of the most important things you can do to keep him or her from getting sick. HIV+ children are immunized for most diseases the same way as children without HIV. These include diphtheria, tetanus, pertussis (DTaP) vaccine, polio (IPV) vaccine, H. flu type B (HiB) vaccine for meningitis, pneumococcus (Prevnar) vaccine, and hepatitis A and B vaccine. All HIV+ children (as well as healthy kids six months to five years old) should get a flu shot every year.
Check with your child’s doctor about any special requirements for vaccines for HIV+ children. For example, HIV+ children can and should get measles, mumps, and rubella (MMR) vaccine, and chicken pox (varicella) vaccine if their CD4 cells are high enough, but should not be vaccinated if their CD4 counts are very low.
Recognize that no parent can protect a child from every germ. While you may want to keep your HIV+ child from people who have colds and the flu, know that your child will eventually be around someone who is sick. Teach your child to practice frequent and thorough hand washing. Because children often rub their eyes or put their fingers in their mouths or noses, keeping hands reasonably free from germs can help keep your child well. As soon as possible, teach your child how to blow his or her nose.
Any childhood illness can be hard for parents as well as for their kids. As a parent, you might find yourself wishing that you could be sick instead of your child. You may feel frustrated because the treatment or prevention that you need to give your child makes him or her uncomfortable and is hard to watch. You may feel helpless when there is not a good way to explain the situation to your child. You might also feel discouraged if your child gets sick and has diarrhea, which may set back your toilet training goals.
Remember that these are normal experiences and feelings for any parent. While you want your child to be healthy and safe, try to avoid keeping him or her from enjoying normal childhood experiences.
Look for a pediatrician (children’s doctor) who you feel comfortable talking to and who has experience treating HIV+ children. It is helpful to have a local pediatrician who is close by and can help with all of the regular childhood issues, and to consult a doctor who is an HIV expert (especially if your local pediatricians do no have a lot of experience treating HIV+ kids). Expert HIV pediatricians will often work at a children’s hospital or medical center with an HIV program.
HIV drug treatment (sometimes called highly active antiviral therapy or HAART) works very well for children. Talk with your pediatrician about when to start HIV drugs. Starting early might keep HIV from causing more damage to your child’s body. Most HIV+ children start taking HIV drugs by three months old. However, when HIV is diagnosed when the child is older, treatment may depend on the health of the child’s immune system.
The U.S. Department of Health and Human Services has put together a set of pediatric treatment guidelines that recommend which medications children should take first and which medications should not be combined. Ask your doctor about these, as well as about drug interactions and side effects.
There is not as much information available about the use of HIV medications in children as in adults, and not all HIV drugs are available for children. Still, over ten HIV medications are approved for use by children. Finding the right dose is important. Children's doses are based on weight, so dosing will have to be adjusted frequently as your child grows.
Children need to take their HIV drugs consistently. They should take the drugs at the same time each day. Some HIV drugs need to be taken with food while some do not. When talking with your child’s doctor about which HIV drugs your child will take, think about your day and how you will fit in your child’s drug dosing schedule.
Getting children to take medicine can be a real challenge. Children might not like how the medications taste or might have trouble swallowing pills. Older children may hide pills or pretend to take them. Ask your pediatrician or other parents for suggestions about how to help your child take medication. Remember, taking HIV medications consistently is very important.
It is also important for HIV+ children to have proper nutrition. Getting kids to eat right can be hard even when children are not HIV+! Ask your pediatrician or an AIDS service organization for a referral to a dietician who knows about the nutritional needs of HIV+ people.
Work with your pediatrician to keep a close eye on your child’s growth, development, and lab tests (such as viral load and CD4 counts). If you see problems, you may need to consider changing to different HIV drugs. Also ask your child if he or she is experiencing any pain. Staying aware of how your child is feeling will help you to know if he or she has become ill or is experiencing side effects.
Last but not least, it is as important to take care of yourself as it is to take care of your HIV+ child. Here are some tips:
- Find information and resources at a local AIDS service organization.
- Because there are not many HIV+ children in the U.S., you might feel alone. Find other parents who can understand and provide support. If there are no other parents near by who have HIV+ children, find a group for parents of children with other on-going health care needs or look for an internet group.
- If you are HIV+, take care of your own emotional and physical health. Many parents put their children’s health first. You need to stay healthy to help your child.
- If you have other children, find special time for them too.
- Remember that it is okay to ask for help from family and friends. Being a parent is a full time job, only you do not get sick or vacation days. Take a break sometimes!
| 1 | |
Ammann, A. (2002). Recommendations for immunization of infants and children: Retrieved September 2006 from |
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U.S. Department of Health and Human Service. (2005). Guidelines for the use of antiretroviral agents in pediatric HIV infection: Retrieved September 2006 from http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=8&ClassID=1 |
