When a person is first infected with the human immunodeficiency virus (HIV), he or she may have no symptoms or may become ill with a fever, night sweats, sore throat, general tiredness, swollen lymph glands, and a skin rash lasting for a few days to a few weeks. These early symptoms then go away by themselves. However, the virus stays in the body (becomes a chronic infection) and causes increasing loss of immune function that results in the body becoming unable to fight off infections to which we are all normally exposed. The late stage of this infection is called acquired immunodeficiency syndrome (AIDS). A person who is infected becomes potentially infectious to others for life.

Early symptoms of HIV infection in children include failure to grow and gain weight, chronic diarrhea without a specific cause, enlarged liver and spleen, swollen lymph glands, chronic thrush (yeast infections) and Candida (yeast) skin infections, pneumonia, and other bacterial, viral, fungal, and parasitic infections that healthy children do not usually get. However, many children are infected with HIV for many years before developing any symptoms.

HIV is not easily transmitted. HIV is most commonly spread:

By sharing contaminated needles for intravenous drug abuse.
Through sexual intercourse.
By infected pregnant women to the fetus.
By exposure to infected blood through a blood transfusion.
Less commonly, HIV may be spread:
By infected mothers who breastfeed their infants.
Occupationally to health care workers, primarily after being stuck with a needle containing HIV in infected blood.
By exposure of open skin or mucous membranes to HIV contaminated body fluids. (Although it is very rare, a few cases have been reported in which HIV was spread by contact with blood or other body fluids from an infected person.)

No vaccine against HIV is available; however, HIV is not likely to be spread from one child to another in a childcare setting, and no such case has ever been reported. The child's parents or guardians should inform the family home provider or center director when an HIV-positive child is admitted to childcare. Because of concern over stigmatization, the person aware of a child's HIV infection should be limited to those who need such knowledge to care for the children in the childcare setting. In situations where there is concern about the possibility of exposure of others to infected blood or other body fluids, a child who is infected with HIV should be evaluated by a team that includes the child's parents or guardians, the child's physician, public health personnel, and the proposed child care provider to determine the most appropriate child care setting. This evaluation should consider the behavior, neurologic development, and physical condition of the child and the expected type of interaction with others in the childcare setting. In each case, risks and benefits to both the infected child and to others in the childcare setting should be weighed.

Children with HIV infection need to be closely monitored by their physicians because they are more susceptible to severe manifestations of infectious illnesses than are other children. Children with HIV infection should receive childhood vaccinations (diphtheria-pertussis-tetanus vaccine, measles-mumps-rubella vaccine, inactivated polio vaccine, Haemophilus b conjugate vaccine, influenza vaccine, and pneumococcal vaccine) following the immunization schedule. Parents of children with weakened immune systems, whether due to HIV infection or other causes, should be advised when certain infectious diseases, such as cryptosporidiosis and fifth disease, have occurred in the child care setting. Such children may need to be removed from the childcare setting until the outbreak has subsided in order to protect them from infections that could have severe complications for them.

If a childcare provider has a weakened immune system, he or she should discuss with his or her physician precautions to be taken to avoid becoming infected with the many infections that young children are likely to transmit.

To reduce the risk of spread of HIV in the childcare setting, all childcare providers should routinely follow precautions necessary to prevent the spread of any blood borne infection (including hepatitis B):

Make sure all children and adults use good hand washing practices.
Make sure all adults use good diapering practices.
Wear gloves when changing a diaper soiled with bloody stools.
Wash skin on which breast milk has spilled with soap and water immediately.
Do not allow children to share toothbrushes.
Clean up blood spills immediately.
Wear gloves when cleaning up blood and body fluid spills unless the spill is so small it can be contained in the cloth or towel being used to clean it up.
Disinfect any surfaces on which blood or body fluids have been spilled with freshly prepared bleach solution.
If a childcare provider has open sores, cuts, or other abrasions on the hands, wear gloves when changing diapers or cleaning up blood spills.
Cover open wounds on children and adults.

You should develop policies and procedures to follow in the event of an exposure to HIV. See procedures for HIV exposure through expressed breast milk or other body fluids in Nutrition and Foods Brought from Home section. A person who has had a severe exposure may need to be treated with antiviral drugs.

© January 1997