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Statistics
Children born to HIV infected mothers: year of
birth by infection status (cases reported until the end of September 2003
Infected AIDS
494
Not AIDS 529
Indeterminate
943
Not infected
1855
TOTAL
3821
Approx 1000 HIV+ children, of which 750 live in
London
Reference: SOPHID data from the HPA
website
Percentage of HIV Positive
adults who are women = 47%
Routes of
Transmission of HIV to
Children
Mother to child:
via placenta
during the birth process
via breast milk
transmission rate approx.
10-15 % in
Europe.
(pre-1993)
HIV can also be transmitted to
children through:
infected blood
or blood products, exposure through use of infected needles,
sexual intercourse including abuse
The risk of mother to child
transmission can be significantly reduced by use of anti-retroviral drugs to
reduce mothers viral load during pregnancy and delivery, caesarean section
rather than vaginal delivery, anti-retroviral drugs to the infant for the
period immediately after delivery and not breast feeding.
Clinical
Presentation of Paediatric HIV/AIDS
Clinical Indicators of
Paediatric HIV Infection.
recurrent fevers
failure to thrive, poor
feeding, severe weight loss
bacterial infections
skin problems- eczema, herpes
simplex, Candida
recurrent/ chronic diarrhoea
recurrent/ chronic oral thrush
developmental delay
upper
respiratory tract infections
Potential Neurological Deficits within the Developing
Central Nervous System
HIV. may enter
and affect the childs developing central nervous system both in-utero and
during the first few years of life.
This central nervous system
involvement can include a wide range of neurological symptoms such as:
Brain lesions which can lead
to a clinical picture of cerebral palsy
Impact of chronic viral
infection on the developing brain resulting in generalised developmental
delay including motor, cognitive and language skills
Progressive encephalopathy
-delayed motor development, loss of motor milestones and functional
skills
-progressive motor dysfunction
-hypotonia / hypertonia
Opportunistic
Infections
Opportunistic infections are
those which have an opportunity to affect a person due to a deficient immune
system.
Opportunistic infections can
also affect the central nervous system on a secondary basis and contribute
to neurological deficits caused directly by the HIV.
There are differences between
adults and children in disease progression and typical opportunistic
infections that present. Refer to the literature references for further
details.
Psychosocial Impact
Issues can include
understanding and coping with illness- both the childs own and/or that of
other family members. Managing changes to routine, environment and adapting
to changing level of well-being , abilities and skills. Coping with
bereavement and loss.
Many of the families attending
The Sun Clinic come from sub-Saharan
Africa.
Many are refugees so present with additional issues from their backgrounds
and experiences as well as difficulties in current living situations.
A picture by one of the children from the Sun
Clinic
Occupational Therapy for HIV Positive Children
Occupational Therapy aims to
promote and maintain each childs development and maturation as far as
possible
using a holistic, child-centred approach.
Specific treatment approaches
and areas of intervention include:
neuro-developmental
sensory-motor
including fine and gross motor skills
perceptual-motor
visual perceptual skills
developmental/cognitive
interventions including work on memory skills, processing and
concentration/attention
self-care skills- including
bathing, toiletting and dressing
independence skills training,
daily management and advice on energy conservation
equipment including seating and
buggies/wheelchairs for children with severe neurological conditions
housing
adaptations and reports to support re-housing on grounds of medical and
functional independence needs
Regular review and monitoring are vital due to the progressive nature of the
condition. Deterioration in functional abilities and skills often correlates
to increasing viral loads and disease progression.
Use of standardised
assessments and outcome measures are valuable to monitor progress and
disease progression. A range of paediatric assessments are available
including:
-Movement Assessment
Battery for Children- (Henderson and Sugden); Test of
Visual Motor Integration (
Berry);
Developmental Test of Visual Perception 2 (DTVP-2); Bayley Scales of
Development.
Intervention may include :
assessment and occupational
therapy programme for home and/or school use
individual therapy sessions
group work
Changing
Trends and Implications for Future
Occupational Therapy Service Provision
There is a need for
occupational therapists within paediatric services to be aware of the
increasing numbers of children present with HIV.
With Government policy of
increasing country-wide dispersal of immigrants and asylum seekers children
with HIV. may present at more localised services.
The move from HIV. being an
acute and life-threatening infection to a chronic relapsing condition has
increased and in some ways altered occupational therapy focus. Developmental
and functional skills are a focus to promote maturation and independence
and to maintain this as far as possible.
With the advance of anti
-retroviral drug therapy children are surviving longer but presenting with
chronic difficulties e.g.: soft neurological deficits affecting function.
This includes increased numbers of children with difficulties with fine
motor skills, pencil skills, visual-motor integration, visual perception,
concentration/attention, memory.
With children surviving into adolescence and
adulthood there will be a developing role for occupational therapists within
the area of work , life and leisure skills.
The Sun Clinic
The Sun Clinic offers a
family-centred range of services to parents/carers and children who are
infected or affected with/by HIV / AIDS
The service began five years ago and has seen steadily increasing numbers of
families using the service. There is a multi-disciplinary team in place to
meet the medical, developmental, psychological and social care needs of the
children and their families. A clinic is held weekly.
The Occupational Therapy post has increased from part time to full time in
recognition of increasingly varied and long-term occupational therapy needs
amongst the children.
Kate. Collins S.R.O.T.
Senior I Occupational Therapist
Sun Clinic
Newham Primcary Care Trust
September 2002,
updated March 2005
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