HIV/AIDS—Child Care and Schools

What is HIV/AIDS?

Human immunodeficiency virus (HIV) infection affects the body in a variety of ways. In the most severe infection, the virus progressively destroys the body's immune system, causing a condition called acquired immunodeficiency syndrome (AIDS). With early testing and appropriate treatment, children in the United States rarely develop the severe signs and symptoms of HIV infection.

What are the signs or symptoms?

Children with HIV infection may show few signs or symptoms. Children with HIV infection may have

• Unexplained fevers

• Failure to grow and develop well

• Enlarged lymph nodes

• Swelling of salivary glands

• Enlargement of the liver and spleen

• Frequent infections, including pneumonia, diarrhea, and thrush (ie, a yeast infection on the surfaces of the mouth)

• Inflammation of the heart, salivary glands, liver, and kidneys

• Central nervous system disease

• Specific types of tumors

What are the incubation and contagious periods?

• Incubation period: If the infection is acquired before or during birth from infected individuals, untreated children typically develop signs or symptoms between 12 and 18 months of age, although many remain symptom free for more than 5 years.

• Contagious period: Infected individuals can transmit the virus in their body fluids throughout their lifetime.

How is it spread?

• Blood or blood products.

• Sexual contact.

• Children born to infected individuals may become infected during birth.

• Contaminated needles or sharp instruments.

• Saliva that contains blood.

• Frequent contact with open sores or the fluid that comes from open sores that contains blood.

• Direct exposure to blood through injury, bites, or scratches that break the skin, introducing blood or body fluids from a carrier to another person.

• Can be transmitted from breast milk. If an infant has been mistakenly fed another infant's bottle of expressed human (breast) milk, the risk of HIV transmission from human milk is low. Transmission of HIV from a single milk exposure has never been documented. For a detailed discussion of what to do if the milk of one mother is fed to an infant of another mother, see Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, Standard 4.3.1.4 (https://nrckids.org/CFOC).

• HIV is not spread by the type of contact that occurs in early childhood education (ECE) and school settings, such as in typical classroom activities or with surfaces touched by infected people. It is not spread through nonbloody saliva, tears, stool, or urine.

How do you control it?

• Standard Precautions (see Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition) should be followed when blood or blood-containing body fluids are handled. For blood and blood-containing substances, these are the same precautions described by the US Occupational Safety and Health Administration (OSHA) as Universal Precautions.

What are the roles of the educator and the family?

• Parents/guardians, including those of children with HIV, should be notified immediately if a case of a highly contagious disease, such as measles or chickenpox, occurs in an educational setting. Children with HIV infection may be at increased risk of severe complications from certain infections. Parents/guardians should consult their child's health professional if their child is exposed to a potentially harmful infectious disease.

• Parents/guardians of a child with HIV are not required to disclose their child's HIV status but may choose to do so confidentially to request closer monitoring for illness. If shared, this information must not to be disclosed to staff members without written permission of the parents/guardians. Only the child's parents/guardians and health professional need to know the child's HIV status.

• All staff members in ECE and school settings should receive annual education about Standard Precautions (see Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition), which include OSHA requirements for Universal Precautions.

Exclude from educational setting?

No, unless a child with known HIV exhibits any of the following signs or symptoms. In such cases, admission should be assessed on an individual basis by the child's health professional in consultation with child care staff members:

• The child has weeping skin lesions that cannot be covered.

• The child has bleeding problems.

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• Exposure to a highly contagious disease (eg, measles, chickenpox) occurs at the facility. Parents/guardians of children who have a weakened immune system can ask their child's primary health professional whether the child should have preventive measures, including removal from the educational setting, to reduce the risk.

• The child has symptoms that require exclusion according to the child's individual care plan.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

• Children with HIV infection should not be excluded from ECE or school settings because of concerns about transmission risk. As long as their health status allows participation, they should be admitted. Children with HIV should be treated the same as other children.

Readmit to educational setting?

Yes, when all the following criteria are met:

• If a child is excluded because of risk of exposure to highly contagious infections in an educational setting, they may return once their health professional confirms it is safe to do so.

• When skin lesions are dry or covered.

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.