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PEDIATRICS Vol. 105 No. 6 June 2000, pp. 1358-1360
AMERICAN ACADEMY OF PEDIATRICS:
Education of Children With Human Immunodeficiency Virus Infection
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ABSTRACT |
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Top
Abstract
Conclusion
Recommendation
References
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Treatment for human immunodeficiency virus (HIV) infection has enabled more children and youths to attend school and participate in school activities. Children and youths with HIV infection should receive the same education as those with other chronic illnesses. They may require special services, including home instruction, to provide continuity of education. Confidentiality about HIV infection status should be maintained with parental consent required for disclosure. Youths also should assent or consent as is appropriate for disclosure of their diagnosis.
Asymptomatic children with human immunodeficiency virus
(HIV) infection cannot be distinguished from children without
infection, and their educational opportunities should be the same as
other children. Children and youths with HIV infection should not be excluded from school or isolated within the school
setting.1 The spread of HIV infection in school has not
been documented, and fear of its communicability must be allayed by
appropriate education of all school personnel. Participation in school
provides a sense of normalcy for children and adolescents with HIV
infection and offers opportunities for socialization that are important to their development. School attendance promotes a sense of belonging and reduces feelings of isolation and rejection.2 Those with HIV infection should participate in all activities in
school3,4 to the extent that their health permits, which
includes a spectrum of illness ranging from no symptoms to acquired
immunodeficiency syndrome (AIDS). The need to exclude children or
youths with HIV infection from school to protect their own health is
unusual. Such a decision should be made by the physician in
consultation with the child's parent or caregiver.
The majority of children with HIV infection reaching school age
have normal cognitive function.5-8 When symptoms develop
in a child or adolescent with HIV infection, central nervous system
(CNS) dysfunction can occur and cause a decrease in cognitive function
followed by a decline in academic performance. Controlled clinical
trials of antiretroviral therapy have shown improved neurodevelopmental
function in symptomatic children.9 Clinical trials have
also shown that with different antiretroviral therapy, CNS disease
occurs at different rates, indicating that optimal therapy can delay or
prevent CNS dysfunction.9 The pediatrician should ensure
that initiation of developmental testing, evaluation of CNS function,
and appropriate referral of children and youths to early intervention
and special education programs are the same as for children and youths
with other chronic illness that can require such services. Physical education programs suitable for the needs of the developmentally disabled or chronically ill child, including those with HIV, should be
available.
Important protections exist for children and adolescents with
disabilities including HIV infection. Several laws have been enacted to
improve the availability of services in schools to assist children with
special health care needs to benefit optimally from
education.10 The pediatrician should be familiar with
federal disabilities rights laws.
The Individuals With Disabilities Education Act (IDEA), as reauthorized
in 1997, is an outgrowth of the Education of All Handicapped Children
Act of 1975 (PL 94-142) and the Education of the Handicapped Act
Amendments of 1986 (PL 99-457). IDEA is a federal program that applies
to children and youths, ages 3 to 21 years, with developmental
disabilities and health impairments. It includes a provision to
encourage states to expand opportunities for children younger than 3 years who would be at risk of having substantial developmental delay if
they did not receive early intervention services. IDEA guarantees
access to needed educational services and provides for related services
that may be required to assist a child with a disability to benefit
from special education. Related services include transportation, speech
pathology, audiology, counseling, physical therapy, and medical
services for diagnosis. For persons to be eligible for services under
IDEA, their condition, specified by the law, must have the potential to
interfere with the educational process and normal school performance
and requires special educational-related services.
For infants and toddlers birth to age 3 years with disabilities, an
annual Individual Family Service Plan (IFSP), which is a component of
IDEA, is developed to provide early intervention services. For children
and youths 3 to 21 years of age who require special assistance, schools
must prepare an Individualized Education Program (IEP) and update it
annually. The IEP sets out a plan for special education and related
services to meet the child's education goals. The plan is designed by
a multidisciplinary team that includes the student's parent(s),
regular education teacher, special education teacher, a representative
of the school administration, and, when appropriate, the student.
Ideally, the IEP team may include the pediatrician and school nurse who
are knowledgeable about the student's condition.
Section 504 of the Rehabilitation Act of 1973 is available for any
children or adolescents with special health care needs and is
applicable to those who do not require special education instruction.
It provides the legal support for education in regular classes with the
use of supplementary services including medical, nursing,
psychological, physical, and occupational therapies.
The Americans With Disabilities Act also provides children and youths
with disabilities certain protections by ensuring that schools and
school programs are available and accessible. For example, this act
mandates wheelchair-accessible buildings.
School personnel must be educated about HIV disease and the
potential long-term needs of the infected student. All schools should
have programs for educating school personnel in standard precautions
and in recognition and management of medical
emergencies.11,12 Students with chronic illnesses,
including HIV, may need medications administered during the school day
and established school procedures should be used.13
Confidentiality must be ensured. Under optimal circumstances and with
parental consent (and student assent when appropriate), the person(s)
giving medications should be informed of the student's diagnosis and
the side effects associated with the drugs being taken. In the event
that the HIV diagnosis is not disclosed to school personnel, only the
person(s) directly involved with the provision of medication should be
informed of the student's need for medication. Some medications have
special requirements, such as increased fluid requirements. Appropriate access to fluid and bathroom privileges should occur in response to
physician requests.
Children and youths with symptomatic HIV infection or other
chronic illnesses may be absent from school and need home instruction sporadically until the illness improves, or may require other special
school arrangements including permanent home instruction when the
disease progresses. The policy on home instruction published by the
American Academy of Pediatrics (AAP) provides guidelines for reference,
and schools must meet the requirements and Section 504 of the
Rehabilitation Act of 1973, the Americans With Disabilities Act of
1990, and IDEA.14 Home instruction should be provided
promptly under IDEA guidelines through the special education coordinator working with the school medical advisor and the student's physician. The student's physician should help parents to facilitate the transition between school and other special arrangements, including
home instruction.
The student's ability to continue his or her education may diminish as
disease progresses, and anger, withdrawal, or depression can be
present. The school should continue to work with the medical system to
assist the family with counseling and emotional support. The school may
also assist other students to a better understanding of chronic illness
and how to be supportive of their classmates. Although family
disruption and community rejection occur for students with HIV
infection, they are more common in families who may need assistance
from school mental health personnel.
As long as disclosure of HIV infection can stigmatize students and
families, confidentiality is important. The need to safeguard the
rights of the student must be balanced with information essential to
the school to educate the students and faculty. The primary responsibility of the pediatrician is to care for the child or youth
and the family. Disclosure of the child's HIV status should be done
only with the consent of the parents and age-appropriate assent of the
student. Some families may not permit disclosure, which should not
prohibit the student from attending school. Also, some HIV-infected
children who attend school have not had their conditions diagnosed. An
effective HIV/AIDS education program for school personnel provides
accurate information about HIV infection and its transmission. This
education should provide reassurance to school personnel and a more
accepting environment for the HIV-infected student.11
Specific immunization requirements as recommended by the
AAP2 are designed to be applicable to HIV-infected
children and youth. General immunization requirements for healthy
children are also available in the 1997 Red Book. These
immunization requirements are designed to protect all children and
adolescents and should be rigorously enforced to reduce risk of
exposure to vaccine-preventable illnesses. Parents should be informed
when measles or varicella is occurring in the school
setting.1 Parents of children and youths at increased risk
of developing severe illnesses should consult their physician.
Transmission of HIV from mother to child has been significantly
decreased with treatment, resulting in fewer HIV-infected children
entering preschool and kindergarten. The advent of early aggressive
antiretroviral therapy has prolonged the number of years that children
can attend school,15 enabling many to continue their
education through high school and perhaps higher education. An
understanding by school personnel of chronic illness manifestations
attributable to HIV infection is essential for providing appropriate
educational programs.
HIV INFECTION AND DEVELOPMENTAL DELAY
FEDERAL DISABILITIES RIGHTS LAWS
HIV MANAGEMENT IN THE SCHOOL SETTING
HOME INSTRUCTION
CONFIDENTIALITY
EXPOSURE TO ILLNESS
CONCLUSION
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Abstract
Conclusion
Recommendation
References
RECOMMENDATIONS
Top
Abstract
Conclusion
Recommendation
References
COMMITTEE ON PEDIATRIC AIDS, 1999-2000
Catherine M. Wilfert, MD, Chairperson
Mark W. Kline, MD, Chairperson-elect
Donna Futterman, MD
Peter L. Havens, MD
Susan King, MD
Lynne M. Mofenson, MD
Gwendolyn B. Scott, MD
Diane W. Wara, MD
Patricia N. Whitley-Williams, MD
LIAISON REPRESENTATIVES
Mary Lou Lindegren, MD
Centers for Disease Control and Prevention
CONSULTANT
Martin W. Sklaire, MD
STAFF
Eileen Casey, MS
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; CNS, central nervous system; IDEA, Individuals With Disabilities Education Act; IFSP, Individual Family Service Plan; IEP, Individualized Education Program; AAP, American Academy of Pediatrics.
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REFERENCES |
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Abstract
Conclusion
Recommendation
References
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- American Academy of Pediatrics. HIV infection. In: Peter G, ed. 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:279-304
- Centers for Disease Control and Prevention Education and foster care of children infected with HTLV III/lymphadenopathy-associated virus. MMWR Morb Mortal Wkly Rep. 1985; 34:517-521 [Medline]
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American Academy of Pediatrics, Committee on Sports Medicine and Fitness
Human immunodeficiency virus and other blood-borne viral pathogens in the athletic setting.
Pediatrics
1999;
104:1400-1403
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on Pediatric AIDS and Committee on Infectious Diseases
Issues related to human immunodeficiency virus transmission in schools, child care, medical settings, the home, and community.
Pediatrics
1999;
104:318-324
[Abstract/Free Full Text] -
Gay CL,
Armstrong FD,
Cohen D,
The effects of HIV on cognitive and motor development in children born to HIV-seropositive women with no reported drug use: birth to 24 months.
Pediatrics.
1995;
96:1078-1082
[Abstract/Free Full Text] - Nozyce M, Hittelman J, Muenz L, Durako SJ, Fischer ML, Willoughby A Effect of perinatally acquired HIV on neurodevelopmental growth in children during the first two years of life. Pediatrics. 1994; 94:883-891 [Medline]
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Chase C,
Vibbert M,
Pelton SI,
Early neurodevelopmental growth in children with vertically transmitted HIV infection.
Arch Pediatr Adolesc Med.
1995;
149:850-855
[Abstract/Free Full Text] - Tardieu M, Mayaux MJ, Seibel N, Cognitive assessment of school-age children infected with maternally transmitted human immunodeficiency virus type 1. Pediatrics. 1995; 126:375-379
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Englund J,
Baker C,
Raskino C,
Zidovudine, didanosine, or both as the initial treatment for symptomatic HIV-infected children: AIDS Clinical Trials Group (ACTG) Study 152 Team.
N Engl J Med.
1997;
336:1704-1712
[Abstract/Free Full Text] - Bogden JF, Fraser K, Vega-Matos C, Ascroft J. Someone at School Has AIDS: A Complete Guide to Education Policies Concerning HIV Infection. Alexandria, VA: National Association of State Boards of Education; 1996:79-81
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American Academy of Pediatrics, Committee on Pediatric AIDS
Human immunodeficiency virus/acquired immunodeficiency syndrome education in schools.
Pediatrics.
1998;
101:933-935
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on School Health
Guidelines for urgent care in school.
Pediatrics.
1990;
86:999-1000
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on School Health
Guidelines for the administration of medication in school.
Pediatrics.
1993;
92:499-500
[Abstract/Free Full Text] - American Academy of Pediatrics, Committee on School Health. Medically indicated home, hospital, and other non-school-based instruction. AAP News. February 1992:19
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Barnhart HX,
Caldwell MB,
Thomas P,
Natural history of human immunodeficiency virus disease in perinatally infected children: an analysis from the Pediatric Spectrum Disease Project.
Pediatrics.
1996;
97:710-716
[Abstract/Free Full Text]
Pediatrics (ISSN 0031 4005). Copyright ©2000 by the American Academy of Pediatrics
Statement of reaffirmation:
- AAP Publications Retired or Reaffirmed, October 2006
- American Academy of Pediatrics
Pediatrics 2007 119: 405.[Extract] [Full Text] [PDF]
The following policy statement has been revised:
- Education of Children with Human Immunodeficiency Virus Infection
- TASK FORCE ON PEDIATRIC AIDS
Pediatrics 1991 88: 645-648.[Abstract] [PDF]
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  R. C. Barfield and J. R. Kane Balancing Disclosure of Diagnosis and Assent for Research in Children With HIV JAMA, August 6, 2008; 300(5): 576 - 578. [Full Text] [PDF]
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 Human Immunodeficiency Virus Infection Red Book, January 1, 2006; 2006(1): 378 - 401. [Full Text]
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 C. Kukka Bloodborne Infections: Should They Be Disclosed? Is Differential Treatment Necessary? The Journal of School Nursing, December 1, 2004; 20(6): 324 - 330. [Abstract] [Full Text] [PDF]
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Human Immunodeficiency Virus Infection Red Book, January 1, 2003; 2003(1): 360 - 382. [Full Text]
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 Committee on Pediatric AIDS and Committee on Adole Adolescents and Human Immunodeficiency Virus Infection: The Role of the Pediatrician in Prevention and Intervention Pediatrics, January 1, 2001; 107(1): 188 - 190. [Abstract] [Full Text]
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