Caring for Children with Special Needs: HIV and AIDS

Doreen B. Greenstein, Ph.D.
Developmental Psychologist
Cornell University Extension Service

Human immunodeficiency virus (HIV) is the virus that develops in AIDS, which stands for Acquired Immune Deficiency Syndrome. The virus is not transmitted through everyday contact. No cases of transmission have ever been reported in a child care setting. HIV-positive is a term used to describe someone who has tested positive for the HIV virus. AIDS is the term used when specific diagnostic criteria for loss of immune function are met.

Child care staff probably don't know if a child is HIV-positive because many children have no symptoms, and many adults have not been diagnosed as HIV-positive. The family may not even suspect their child has the virus. Even if they know, parents are not obligated to tell a child care provider. With good reason, they may fear discrimination if they disclose this information. If parents do confide in you, keep the information confidential. Other children are in no danger of contacting the virus from an HIV-positive child so there is no reason to inform other parents.

HIV cannot be transmitted through casual contact in a child care setting. The HIV virus cannot be spread by sneezing, coughing, hugging, or touching. Parents worry about accidents and fights, but fresh blood-to-blood contact among children is extremely unusual.

It is important for child care providers to develop health policies that include use of universal precautions and proper hygiene for all children. These precautions minimize the risk of exposure to infectious illnesses that include, but are not limited to, HIV. Many people have an exaggerated fear about the HIV virus when, in fact, a person's risk for many other infections are far greater.

Universal Precautions

For Cleaning Up Messes

Many infections, including HIV, can be transmitted through exposure to body fluids, that is, blood, bloody saliva, urine, faeces, and vomit. To clean up these spills, wear disposable gloves and wipe with paper towels or disposable rags.

Then wipe the surface with a freshly made solution that contains 1 tablespoon of liquid chlorine bleach for every quart of water (1/4 cup bleach to one gallon of water). Wash the surface and let it air dry. Put used disposable gloves and used rags or paper towels in a closed, leak-proof container (a plastic bag is good) and put in a rubbish container.

After you take off your gloves, wash hands with soap under running water for 10 seconds. A caution about latex gloves is that an increasing number of people are becoming allergic to latex. If you, or a child in your care, reacts to latex gloves, consult your health care professional.

For spills of body fluids on bedding, clothes, or other washables, launder items separately in a normal cycle in your washing machine. Add 1/2 cup bleach to the wash cycle and presoak heavily soiled items, such as nappies.

Wash hands before and after changing a nappy. Wear disposable gloves if there is blood in the faeces or urine, and if you have a rash or open cut on your hands. Place disposable nappies in a leak-proof container, such as a plastic bag, and put it in a rubbish container.

If a child bites you and draws blood, wash the area immediately with soap and water. As you would for any human bite, consult your physician.

At Meal Time

Even though sharing food will not transmit HIV virus. Good hygiene practices do not permit sharing of food. For a child who is HIV-positive, no other mealtime restrictions are needed. Family-style eating is fine with everyone being served from a common serving dish. A child who is HIV-positive should use the same dishes, glasses, and eating utensils. If you have a child in your care who is HIV-positive, you do not have to wash dishes and utensils separately. Wash all dishes in hot, sudsy water.

Clean and sterilize baby bottles as usual.

At Play Time

Sharing toys will not transmit the HIV virus. However, good hygiene practices dictate that if a child has put a toy into her mouth, the toy should be washed in soap and water before another child plays with it.

In the Laundry

Clothes that belong to a child who is HIV-positive can be laundered with everyone else's clothes using ordinary laundry detergent. If, however, the clothing has been soiled by blood, semen, urine, faeces, or vomit, wash items separately using 1/2 cup bleach to the wash cycle.

For First Aid

Keep a first aid kid handy. It should include:

a box of disposable latex gloves,
antiseptic or disinfectant,
a bottle of bleach (to be diluted just prior to use at a rate of 1 tablespoon bleach for every quart of water; solutions mixed in advance lose their effectiveness),
disposable paper towels,
sterile gauze for covering large wounds,
medical tape and adhesive bandages, and
a leak-proof plastic bag for waste disposal.

Resources for Caregivers

Joan C. Verniero has written an excellent children's book about an eight-year-old living with AIDS. You Can Call Me Willy: A Story for Children about AIDS encourages compassion and understanding for children with AIDS. It also shows children who are HIV-positive how they might deal with difficult situations. The book is written for children ages 5-8 years. Details of You Can Call Me Willy: A Story for Children about AIDS

Forgotten Children of the AIDS Epidemic looks at issues facing children whose parents or siblings are living with AIDS. The book, edited by Shelley Geballe, Janice Gruendel and Warren Anidman, shows what they experience, how they are affected, and how they meet their emotional needs. The book has artwork and stories of the children and their caretakers-in the children's own words. Details of Forgotten Children of the AIDS Epidemic

Technical References

Bruder, M.B. (1995). The challenge of pediatric AIDS: A framework for early childhood special education. Topics in Early Childhood Education 15(1): 83-99.
Indacochea, F.J. and G.B. Scott (1992). HIV infection and the acquired immunodeficiency syndrome in children. Current Problems in Pediatrics 22: 166-204.
Kelker, K., A. Hecimovic and C.H. LeRoy (1994). Designing a classroom and school environment for students with AIDS: A checklist for teachers. Teaching

Reprinted with permission from the National Network for Child Care - NNCC. (1998). Caring for children with special needs: HIV and AIDS. North Carolina Cooperative Extension Service. Raleigh, NC.