Hesperian Health Guides
Giving ART to your child
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For ART to work well, you must give the medicine each day, usually at the same time of day. Children can learn that taking a medicine is a part of their daily lives, like washing, eating, or getting dressed. You can teach them this, and encourage them to learn about and help keep track of their medicine.
See some ideas for making it easier for your child to take medicine every day. Ask others what works for them and their children. As your child grows, he will be able to take more responsibility for his medicine.
- 1 Getting ready to start ART
- 2 Basic information about ART
- 3 Different forms of ART
- 4 How much to give
- 5 Helping your child take medicine
- 6 Remembering to give medicine each day
- 7 What to do if you miss a dose
- 8 A healthy child with HIV must keep taking ART
- 9 Work with other caregivers
Getting ready to start ART
Even when you know your child has HIV and needs ART, you might need support to be able to start it or give it every day. Our lives are often complicated, and sometimes it is difficult to manage everything, including taking a daily medicine or giving it to a small child.
At your clinic or in your community, you may be able to:
- register yourself or your child to receive ART.
- learn about ART medicine, how to give it, and how to deal with problems.
- join a food program to help you have enough healthy food to eat, which people with HIV need — especially children — for ART to work well.
- find a support group, where hearing the experiences of others and sharing your own can help you manage the stresses of HIV and caregiving.
- tell a friend, partner, or family member about your or your child’s HIV, so you do not need to hide your need to take the medicine from them.
Basic information about ART
For ART, a person usually takes 3 medicines each day, which may be separate or combined in 1 or 2 tablets or liquids. Giving 1 pill or liquid is easiest. To give any medicine safely, you must know how much to give and when to give it, whether it must be given with food or on an empty stomach, if it can be divided or crushed, and if the medicine has any side effects (discomforts that can accompany taking a medicine, like a dry mouth or upset stomach). Some children have side effects with ART, but most side effects go away in a few weeks. See how to help children with ART side effects.
Knowing a little about what a medicine does may help you to remember to give it each day, to explain to your child why he takes it, or to prepare for how your child might feel and know how to help.
To remember how much medicine to give and when to give it, use one of the forms in How to find resources. You or a health worker can draw the amount and put it under the right time of day. You may need to do this for more than 1 medicine.
|These are 2 ways to remember how often and how much medicine to give.|
Keep track of when you will need to get more ART, so you will not run out and miss any doses. You must give ART correctly every day for the medicine to keep working.
Any missed dose gives HIV a chance to grow inside your child. A few missed doses each month lets the HIV germs change, so some of them are able to survive and multiply even when there is medicine in the child’s body. If this happens, your child will need different ART.
Different forms of ART
ART medicines for children come in different forms, depending on the medicine, the age of the child, and what a clinic has available. Babies need liquid forms of ART or something you can mix with milk or food.
Medicines designed for children include:
- liquids (suspensions or syrups, or powders to mix with water just before giving to the child).
- tablets with child-sized doses.
- sprinkles (tiny “seeds” of medicine you sprinkle on a child’s food).
Tablets for children with child-sized doses make ART more effective for children than using tablets made for adults. The larger-dose adult tablets must be cut into pieces to give the dose the child needs. This means the child might get too much or too little medicine.
Many ART programs try to start children on tablets as soon as they can swallow them. Usually tablets are more affordable and they are easier to store and carry than liquids. Children as young as age 4 can learn to swallow a small tablet.
How much to give
Medicine doses for babies and children need to be measured carefully. Because their bodies are so small, it is easy to give them too much or too little.
Because doses for children are based on the child’s weight, they change as the child grows. Your child should be weighed each time you visit a clinic. The health worker can see if the child’s dose should be changed and you can see how the child is growing.
Measuring tools for medicines
Your health worker may give you a measuring tool for your child’s ART so you give the right amount. Measure medicine very carefully. Wash the measuring tool each time, before and after you use it. When you return for more medicine, you may need to show your health worker you still have this tool and that you have kept it clean.
|Mark on your syringe, medicine cup, or medicine spoon how much medicine is your child’s dose.|
If you use a regular spoon, make sure you know how to measure your child’s dose with it, and use the same size spoon each time. Wash the spoon before and after using it.
Your child might like to decorate a jar or box to store the tool for measuring his medicine. This may make giving the medicine easier.
Some treatment programs use the same tablets older children and adults take, but split them to make the smaller doses young children need. If possible, it is better not to cut or split tablets yourself to make smaller doses. Instead, ask for them to be split at the clinic, hospital or pharmacy, where they have special tools to cut pills. This can make sure the right amount of medicine for your child will be in each piece.
Helping your child take medicine
Starting daily medicine for a baby or child can be stressful. But with time, taking medicine can be a routine that children become used to.
How to make medicine a comfortable routine
Make the child’s ART like a ritual — give it each day at the same time, in the same way, and in the same place. Routines feel good to children and help them go along with taking medicine. Be consistent, relaxed, and firm, and avoid battles or threats. Stay with the child until she has swallowed all the medicine.
If traveling often, you may need to create routines for traveling too.
Always praise a child when she takes her medicine and thank her for cooperating. Even a baby likes seeing your smile and satisfaction when she takes her medicine. This will help her take her ART each day.
A small reward for a child taking all her medicines in a week helps some children.
Sometimes you can distract a child’s attention from the medicine with a song, story, or game. Some children may like it if you make up a song or a game about taking medicine.
Here comes the water to wash the stone away…
Give baby her medicine, then you can take yours.
A good routine will help children take more responsibility for their ART as they grow older. Continue to watch older children as they take their medicine, and tell them you are proud of them.
What to do about bad-tasting medicine
|Push the medicine in slowly so the baby swallows without choking.|
Some ART medicines taste bad to children. This happens more with liquids, but it can also happen if you need to crush a tablet to g ve it. Here are some ways to help children take these medicines.
- For a baby, use a dropper or syringe (WITH NO NEEDLE) and put the medicine far back in the child’s mouth, between his cheek and tongue. He will not taste it as much that way.
- If your child is breastfeeding, give the breast right after giving the medicine.
- Offer a sip of juice, sweet tea, or fruit after the medicine.
- Mix medicine with something the child likes that is easy to swallow, such as mashed fruit. If you mix medicine into food or drink, make sure the child swallows all of it. If not, the dose will be too little.
- Before giving medicine, have the child suck an ice pop or ice cube to dull her sense of taste. Make liquid medicines cold.
- Use different foods to mask the taste, either with the medicine or before or after giving it. Different foods work for different children. Ask other families what has worked for them.
Teach children 4 years or older to swallow pills as soon as possible. Children can learn using small sweets or uncooked and dry beans. Help the child put one on the back of her tongue, and then take a swallow of water. At first, the child may need several swallows of water to swallow a pill. Always watch a young child taking a pill to make sure she does not choke on it or spit it out.
Respond to side effects
If a child feels bad after taking a medicine, he may try to avoid taking it. Most side effects go away after 1 or 2 weeks. There are ways you can help your child be more comfortable while his body gets used to the medicine. Sometimes the medicine that is causing the problem can be switched to another one without problems. See Side effects while taking ART for ways to help your child be more comfortable with side effects.
Remembering to give medicine each day
ART has to be given every day, and works best when the child takes it at the same time or times every day. That way there is always a certain level of the medicine in her blood. This is how ART keeps the HIV level low. Many people like to have a way to keep track of the medicines, to remember to give them, and also to know if they have been taken. For some people, a treatment buddy helps, someone who can encourage and remind you, and may help you solve any problems you have giving the medicine.
With your support and encouragement, an older child can often help think of ways to keep track, and do much of the tracking herself. Younger children need you to remember medicines, though some children will remind you themselves.
Having teenagers take responsibility for remembering medicine is appropriate for how old they are, and helps prepare them for living on their own.
How to make a weekly pill organizer
Many people use a pill organizer with 7 sections, 1 for each day of the week. They fill it on the same day each week. Each day, they know what medicine to give. And if they cannot remember later in the day whether they gave that day’s medicine to the child, they can look and see. You can make a pill organizer out of cloth, wood, tin, or a collection of small bottles, envelopes or other containers. Label each section or container with a day of the week.
|Use wood or plastic to make dividers in a metal tin. Each week, fill the 7 compartments with the pills you need for each day|
Link ART medicine with a daily activity
It can help you remember to give ART if you connect it to another daily activity. For example, give it:
- when waking and dressing your child.
- just before tending animals, or just before the child leaves for school.
- when you hear the morning or evening call to prayer.
- when a certain radio or TV program comes on.
- at sunrise or sunset.
Other ways to remember medicine
- Set an alarm on a watch or mobile phone.
- Agree with a friend to remind each other about giving medicine.
- Make a calendar — paint it on a wall or use paper or a piece of cloth. Mark each day your child takes her medicine.
Sometimes health workers have a chart you can copy and use to keep track. You or the child can mark it each time you give a medicine. If your child likes marking or drawing on her chart, she may take her medicine more easily.
|This chart also has space to show how the child feels each day. See a blank chart you can copy.|
Any family member or older child who can write can help fill out the chart. You can also use pictures to remember new problems or questions that you want to discuss with a health worker at your next visit.
If you often have trouble remembering to give ART on time, think about why it is difficult. For example, if your child’s medicine needs to be taken with food or on an empty stomach and you are giving doses late, maybe your medicine times do not work with your family’s eating times. Talk to your health worker about changing the times you give the medicine.
If you and your child both take ART, ask your healthworker if you can both take your medicine at the same time (but never take your children’s medicines or give your children your medicine).
Share what works for you with others, including your health worker. Your ideas can help other families be better able to take and track their HIV medicines.
Remembering ART when your routine changes
Plan ahead for changes in your routine. Visitors, events, weekends, holidays, and traveling can all upset a routine for taking or giving medicine. If you travel or go out, take the medicines you may need with you. If you know your activities will be different, try to think of how you will remember your child’s ART. If you do not want others to know you are giving your child medicine, think of how to find time alone, such as helping your child bathe or take a nap, or by going for a walk or to a shop.
What to do if you miss a dose
No matter how careful you are, you may miss a dose of medicine. If this happens, give your child her dose as soon as possible. However, if it is almost time for the next dose, wait and give the next dose on time.
So if your child takes ART once a day, you can give the missed dose up to about 12 hours late. For a child who takes ART 2 times a day, you can give a missed dose up to 5 or 6 hours late. This cannot be a regular way to give ART though, only something that happens rarely, if at all. Missing doses can make your child’s ART stop working. If this happens, her HIV level will increase and she will become ill.
If a child vomits just after taking a dose, wait until she feels a little better and then try again. However, if she vomits 30 minutes or more after she took the medicine, she got enough medicine into her system so you do not need to give her more. A child who vomits her ART several times should see a health worker.
A healthy child with HIV must keep taking ART
Within several weeks of taking ART, your child will probably be more active, growing better, and feeling well. Many children on ART look and act completely healthy. It might seem like you could stop giving him ART, or give it less often, but this would be a mistake. Feeling and looking better shows their ART is working, and they need to keep taking ART to stay well.
HIV is a dangerous infection. If someone stops taking ART, HIV will come back stronger and may become resistant to 1 or more of the HIV medicines, making their HIV more difficult to treat. Stronger, more expensive ART medicines with more side effects are often the only ones that will work — if they are available.
If a person is to stay healthy, once he starts taking ART, he must keep taking it and not stop. For more about how to talk to your young child about HIV or taking medicine, see Chapter 5.
Work with other caregivers
Good communication is important when different people give medicine to a child, for example, other members of your family, or a servant, teacher, or babysitter. If other people give your child ART, work together to make sure the child gets his ART at the right times. Help others understand why each dose of ART is important, and how to remember to give the medicine. Also share any ways you have learned to deal with problems, such as how you distract the child, or praise him, or what food helps him take his medicine.