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It is rare today to come across a child who has HIV. Thanks to advances in medical treatment, mothers with HIV are much less likely to pass this on to their newborn and tight controls are imposed over who can donate blood.
The fact that HIV is now less common means that when early childhood service operators and educators come in contact with a child who has HIV or AIDS they may have little understanding and knowledge of it. Ignorance can lead to fear and anxiety, and decisions may be made about the child’s care that are wrong for the child, hurtful for the child’s family, and damaging to the reputation of the early childhood service. Stigmatisation brought on by other people’s ignorance is distressing for a child with HIV or AIDS and the child’s family.
In May 2012, a Northland Childcare Centre was subjected to adverse publicity when it decided to send home an HIV-positive child. The centre was criticised by the AIDS Foundation and the story made the national news over several days. The childcare centre received negative publicity, even though its exclusion of the child appeared to be only temporary while the centre sought information and wanted to work out how to care for the child.
Not knowing about HIV/AIDS and how to care for a child with HIV or AIDs puts everyone at risk of being hurt in some way. This can be avoided if adults are well-informed and if they view the child with HIV or AIDS as being like any other child whose basic needs are for love, respect, and to be cared for within a safe environment.
HIV is not listed in the early childhood service licensing regulations and criteria as a disease or condition for which a child should be excluded. Early childhood services are not expected to limit contact of HIV-positive children with other children or care differently for a child with HIV or AIDS since standard precautions for infection control should be practised to a high level in all early childhood services. (Click here to go to an article on infectious diseases and exclusion requirements for child health and safety).
Below are some guidelines on responding to and caring for a young child with HIV or AIDS. It covers specifically the essentials of what educators and early childhood service providers need to know. This is recommended reading for anyone who intends to work with or who is working with young children and for parents and families whose children may attend an early childhood programme along with a child who has HIV or AIDS.
The following topics are covered:
- Knowing and understanding about HIV and AIDS,
- Disclosure and confidentiality,
- Excluding a child and terminating enrolment,
- Dealing with fear and ignorance, and
- Ensuring a safe environment for all children in your care.
Knowing and Understanding
What is HIV? The Human Immunodeficiency Virus acts by weakening a child’s immune system, depleting the supply of white blood cells, and this can lead to illness with the child becoming susceptible to secondary infections or complications. The most common complications include bacterial pneumonia and ear infections. There is no greater risk of transmission of these conditions by a child with HIV than a child who does not have HIV or AIDS.
AIDS stands for Acquired Immunodeficiency Syndrome. This is caused by the immune system being depleted of its cells by HIV. Once enough of these cells have been destroyed by HIV, the body is not capable of fighting off other bacteria and viruses easily. It is usually first diagnosed or indicated when opportunistic infections and other specific conditions are detected. Pneumocystic-Carinii Pneumonia is a common infection affecting children with HIV, along with hepatitis and renal disease.
The HIV virus is not known to be transmitted through casual everyday contact between children. Transmission cannot occur through sneezing, preparing food, hugging, kissing, or nappy changing – unless visible blood is present. If a toddler with HIV bites another child the bitten child is not at risk of contracting the virus.
When blood is present there is a risk. In this case standard precautions must be taken and these precautions are the same as for dealing with the control of any infections and contact with blood, as required within early childhood programme by both Health and Education (early childhood) regulations.
Disclosure and Confidentiality
A child’s medical information is personal information and is protected under New Zealand’s Privacy Law. Personal information about a child or family should not be communicated in any way to other children, families, or to anyone else without permission.
Early childhood services should emphasise to parents that medical information is kept private to encourage parents to disclose as much information about their child’s health as possible. If families believe that by providing and not withholding information about a child’s health, they are helping the service to identify needs for staff training and to develop plans for providing the best care at all times, then families will have greater confidence that their child will be supported rather than discriminated against.
Excluding a Child and Terminating Enrolment
Failure to disclose health information is not likely to be a sufficient reason to exclude a child and may be viewed as discrimination. Other reasons such as non-payment of fees, a breakdown in parent-staff relations or physical aggression may be just cause for termination of enrolment providing the family has first been given sufficient opportunity to address concerns.
Should a child with HIV/AIDs have a secondary infection (e.g. chicken pox or measles) which does pose a risk then the family may be asked to keep the child at home until the risk has passed, just as would happen with a child who does not have HIV/AIDS.
Note that children who are HIV-positive may not show any symptoms, and even their parents may not be aware of their child’s condition. Similarly, an early childhood service may employ staff who have HIV but have not been diagnosed. Therefore, whether or not an early childhood centre knows it has an HIV-positive child attending, it should strive to ensure a safe environment for all children (see more about this below).
Dealing with Fear and Ignorance
HIV/AIDS is not covered in most teacher education programmes and so although teachers are professionals who are responsible for caring for children they may be in no better position than a person on the street when it comes to knowing how to respond to a child who has HIV/AIDS.
Not knowing about HIV/AIDS can also mean that teachers will not understand what is involved in caring for a child, leading to fear and possibly hysteria. To counteract this, make sure your centre has expert advice and support and consider contacting your local GP or the AIDS Foundation for information. They may be able to visit and provide information (through dialogue) for parents, a training session for educators, and perhaps leave pamphlets or resources with you.
Present information and engage in discussion in an objective way and help others to approach this sensibly. The problem is not the child who has HIV/AIDS, the problem is making sure that there are policies for infection control and confidentiality, and that these are understood and applied consistently and appropriately by everyone. Reinforce to other parents and everyone involved that there has been no known cases of HIV transmission in early childhood education programmes, and that tens of thousands of children in NZ attend early childhood education and probably billions of children internationally.
Ensuring a Safe Environment for All Children in Your Care
Caring for a child with HIV or AIDS helps to make everyone aware of the need to ensure that standard precautions for infection control are practised to a high level.
Not all children with HIV infection can safely tolerate the standard childhood immunisations as set out on the Immunisation Schedule. So it is especially important for the sake of children with HIV/AIDS for an early childhood service to have high standards for infection control.
Following these precautions, such as hand washing before eating and after toileting, makes it safer for everyone, and means children are less likely to contract an infectious disease of any kind.
To ensure a safe environment for an HIV/AIDS child as well as for all other children, the early childhood service should regularly evaluate or audit its infection control procedures, keep health and safety policies up to date, and seek training and support to ensure best practices are in place.
A written set of procedures which is communicated well to all adults helps consistent practices to be implemented for such things as, the cleaning of surfaces, cleaning of toys, use of disposable gloves when coming into contact with blood, and the disposal of items that may carry infectious material.
When setting annual budgets and making spending decisions be clear that children’s (and adults) health and safety is the bottom line in an early childhood programme and that spending on supplies for infection control such as gloves, disinfectants, and plastic disposable bags cannot be cut back.
In early childhood programmes a good parent-educator-management relationship built on trust and openness is vital so the child’s health and any changes and challenges can be discussed honestly and everyone is in agreement and supportive of the way the child is cared for.
Attendance requirements may need to be more flexible if a child is ill frequently or for long periods which result in absences from the ECE service.
There may be some activities that a child with low immunity should not participate in and this should be discussed and decided upon with the child’s family. Otherwise the child with HIV/AIDS should not be restricted from participating in any activity and should have the same freedom of movement like any other child.
Medicine (prescription and non-prescription) should not be given to a child at an early childhood service, in accordance with the health and safety practices criterion of the Education Regulations, unless it is given:
- by a doctor or ambulance personnel in an emergency; or
- by the parent of the child; or
- with the written authority (appropriate to the category of medicine) of a parent.
Under regulations early childhood services have a responsibility to ensure that no person (adult or child) who has an infectious disease comes in contact with other children whilst at the service. When a child or adult becomes ill while attending the early childhood service, the child must be kept at a safe distance from other children and returned to the care of a parent or caregiver as soon as possible.
Early childhood services should be open to caring for children with illnesses, however the health and wellbeing of all children and families using the service must also be considered. By following simple guidelines, ECE services can open their doors to children with conditions such as HIV while maintaining safety. Caring for a child with HIV or AIDS may seem daunting at first but with a little planning, it is an achievable goal and one that services should not shy away from.
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If you have a particular childcare or early education issue to report please contact us directly. Further information on child health and a range of other topics and issues can be found on ChildForum’s ECE Network website.
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