Many children and young people living in London are affected by HIV. Most such children come from families from sub-Saharan Africa. Some HIV-positive parents have died, some are ill, and some are well. Some older children know that their parents are infected with HIV, but most children are unaware. To help these children understand their situations, children with a parent or parents who have died or are very sick are invited to 6 half-days of storytelling and play, led by a family counselor and someone who uses drama. Trained volunteers come from local AIDS organizations. The sessions vary depending upon what the children choose to discuss. The adults' role is to help the children begin to reflect upon their feelings in a way which is easy for them to express. Sessions usually begin with the creation of a story using a toy animal, after which children subsequently act out the imaginary family in different ways.
During the next 10 years, more than 40 million children will lose either one or both parents from AIDS, mostly in sub-Saharan Africa. In countries with a high rate of HIV infection, more than 33% of children will be orphaned and at risk of being moved from one household to another, or left to live alone in child-headed households. Many children are first affected by HIV when their parents develop HIV-related illnesses and become too sick to work or take their children for health care services, such as immunization and growth monitoring. In caring for their younger siblings, older children miss school. Children in households affected by HIV are often at considerable risk of poverty and malnutrition. Health workers and community-based workers can help protect the health of children affected by HIV by encouraging the establishment of community-based orphan support programs, recognizing HIV-affected families in greatest need and children at risk, and providing at-risk orphans with clothing, housing, food, and school fees.
Although most infants infected with HIV manifest no symptoms of their infected status at birth, HIV-infected children usually develop clinical signs of HIV/AIDS much sooner after infection than do adults. A small percentage of children manifest no signs of HIV infection until reaching age 10 years or older. More than half of all HIV-infected children live for more than 5 years. It is extremely important that HIV-infected children lead normal lives, being allowed to play with friends, go to school, and play sports. Such children cannot transmit HIV to others through everyday activities. HIV status need not be known for the majority of infections an HIV-infected child is likely to have. Rather, such children need the same preventative care as all children, including routine immunization, good nutrition, basic hygiene, the prompt treatment of illnesses, and regular growth monitoring. Common illnesses in children with HIV infection include candidiasis, recurrent fever, recurrent bacterial infections, persistent diarrhea, chronic cough, and skin diseases. HIV-specific illnesses include pneumocystis carinii pneumonia, cerebral toxoplasmosis, and cryptococcal meningitis. Supportive care should be provided to sick children to relieve symptoms and reduce pain.
Each year, measles kills more than 1 million children in developing countries, especially malnourished children and children with complications. Prompt hospital admission is required to prevent measles-associated deaths if children with measles exhibit a general danger sign (lethargy or unconsciousness, convulsions, inability to eat or drink, or vomiting), signs of xerophthalmia, deep or extensive mouth ulcers, severe pneumonia, severe dehydration, or severe malnutrition. No drug can treat this viral infection; measles management consists of treating complications. Health workers must insert a nasogastric tube to administer liquid foods and fluids in children with severe measles who cannot eat. They should clean both eyes with a clean cloth and water 3 times a day. They should apply tetracycline eye ointment 3 times a day for 7 days. They should give a child with signs of xerophthalmia a treatment dose of vitamin A and another dose 3 weeks later. Health workers need to clean the mouth with clean water and a pinch of salt at least 4 times a day and put 1% gentian violet on mouth sores after cleaning. They should treat an anaerobic mouth infection, indicated by a foul smelling discharge, with metronidazole. Measles patients with an acute ear infection should receive paracetamol for pain and fever and an antibiotic for the infection. In the case of ear discharge, the health worker must clean the ears at least twice a day with cotton wool or a clean cloth. They should encourage mothers of measles patients with diarrhea to continue breast feeding. Health workers must administer more fluids than usual. They need to monitor hospitalized children to detect any additional complications. They need to look for danger signs; record the child's temperature, pulse, and respiratory rate twice a day; and weigh the child daily. Children with measles must be isolated for 4 days after onset of the rash. Any child in contact with the ill child should receive a dose of measles vaccine if he/she has not already been vaccinated or had measles. A vaccine coverage rate of at least 90% is the best way to prevent measles and measles-associated deaths.
Children with severe dehydration, persistent diarrhea with dehydration, or bloody diarrhea with no signs of improvement must be hospitalized. In-patient care for a child with severe dehydration includes rapid intravenous (IV) fluid therapy. Children who can still drink should be given oral rehydration salts (ORS) solution while the health worker sets up the IV drip. Children with difficulty drinking should be given ORS as soon as the IV fluid therapy restores their ability to drink (within 3-4 hours for babies, or 1-2 hours for older children), since ORS amends mineral deficiencies more effectively than the IV fluids. The IV drip should be re-administered if the child still exhibits dehydration after 3 hours for older children or 6 hours for babies. If improvement is noted, health workers should encourage the mother to administer ORS and to breast feed frequently. Hospital personnel should observe the child for at least 6 hours before discharge. This allows them to be sure that mothers can maintain the child's fluid balance. Children with diarrhea for more than 14 days face malnutrition or death. Any child with persistent diarrhea who exhibits moderate or severe malnutrition and signs of dehydration and is less than 4 months old needs to be admitted to a hospital. Management of persistent diarrhea involves fluid replacement, appropriate diet, and treatment of associated infections, if needed. ORS is usually effective for persistent diarrhea, although in a few cases poor absorption of glucose may necessitate initial rehydration with IV therapy. Breast feeding is encouraged for infants. Older infants and young children should eat 6 times a day as soon as they are able to eat. Recommended diets for these children are a low lactose diet (milk, yogurt, or curds; cooked rice; oil; sugar/glucose) and a low starch and no lactose diet (eggs, chicken, or fish; cooked rice; oil; sugar/glucose). Children with serious infections may require nasogastric feeding at first. Shigella bacteria tend to be responsible for dysentery. Children with this bloody diarrhea should be treated with an antibiotic. If their condition does not improve and they are malnourished, less than 1 year old, were initially dehydrated, or have recently had measles, they need to be hospitalized. Drugs to reduce frequency of stools should never be given in cases of bloody diarrhea. Older babies and children should be given an extra meal and supplementary vitamins and minerals each day for two weeks.
