Hesperian Health Guides
Testing babies and children
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Babies with HIV can live healthy, full lives if they are tested and start taking ART early in their lives. Testing saves lives.
Babies from birth to 18 months may need 2 different tests — an antibody test and a viral test — and may be tested several times as they grow. For children older than 18 months who have stopped breastfeeding, HIV testing is the same as testing for adults.
- 1 Children who should be tested for HIV
- 2 Testing a baby younger than 18 months old
- 3 Testing a child 18 months or older
Children who should be tested for HIV
If a child’s mother has HIV
The main way HIV infects children is that it spreads from women with HIV who are not taking ART to their babies during pregnancy, birth, or, less often, breastfeeding. But not all children are infected. If you have a baby and you know you have HIV, have your baby tested.
If any person in a household has HIV, health workers usually want others in the family to be tested, especially other children. Sometimes an HIVinfected child seems to be healthy in the first few years of life and is only discovered to have HIV by testing after a sibling or parent is diagnosed.
If a child is ill or grows poorly
Any child who is sickly or grows or develops slowly — and the child’s mother — should be tested for HIV. Health problems that are very common in children with HIV who are not on treatment include:
- tuberculosis (TB) in the child or the child’s household.
- ear discharge.
- swollen glands under the jaw.
- white spots in the mouth (oral thrush).
- very low weight or not growing as expected.
See Chapter 12 for more about common illnesses and how to treat them in children affected by HIV.
While watching for and responding to signs of illness is important, babies can show no signs of illness but still have HIV infection. They need ART in order to stay healthy.
Some mothers may put off having their children tested because they fear learning the child has HIV, or fear discovering that they have HIV themselves. But HIV will not go away on its own. Knowing a child has HIV means you can do things for her, including guarding the child’s health, getting the right treatment, and watching the child improve as treatment is successful, just as learning you have HIV means you can get the treatment you need to stay well.
Rukia is so often ill. I am worried about her.
I can treat Rukia’s fever. But she is very small for her age and should be standing by now. Will you let me test her for HIV?
If a child’s mother or father died
It may also be a good idea to test children for HIV if one or both parents died from unknown causes, or from pneumonia, tuberculosis (TB), or other diseases common in people with HIV.
Other reasons to test a child for HIV
If a child has had injections, blood transfusions, was circumcised, or was breastfed by someone other than her mother, the child may have been exposed to HIV. Also, sexual abuse spreads HIV (see Chapter 14). Discuss any concerns with a health worker, who may recommend testing your child to be sure.
Testing a baby younger than 18 months old
When to test a baby
If possible, test your baby at 4 to 6 weeks of age, or as soon as possible after that. If your health worker knows you have HIV, she may skip the HIV antibody test and use a viral test for your child.
A baby whose mother has HIV should be tested again at about 9 months old even if she is not small or sickly. If that antibody test is positive, test again with a viral test. If that test is positive, start the baby on ART. See Chapter 11.
What test to use for a baby
The best test for a baby younger than 18 months old is a viral (PCR or NAT) test. The HIV antibody test is less costly, more widely used, and gives faster results. But in a baby younger than 18 months, an antibody test cannot tell if antibodies come from the mother or the baby. A positive antibody test only shows that the mother has HIV and her baby was exposed to it. More information on these tests is below.
How they do the test
Hold your baby closely, with 1 hand or foot free so the health worker can take a little blood from it. It helps to talk to a baby and soothe his discomfort, if any, during and after the test.
The health worker will clean the spot where she will take the blood, hold the baby tightly so he cannot move, and prick his finger or foot to take a little blood for the test. She may put a small bandage on the spot.
If your baby has a positive test
A positive antibody test means the baby has been exposed to HIV, but does not mean the baby has HIV. The closer your child is to 18 months old, however, the more likely it is that the antibody test results are correct. If a viral test is available, the baby should have that test to confirm the antibody test result. You will have to return for the results of the viral test, usually in a few weeks.
If no viral test is available, your baby may be started on ART after only the antibody test if he has certain illnesses common with HIV.
Simply knowing that a baby was exposed to HIV is useful because it lets you know that you must protect the child from illness more carefully. One way to do this is to give children cotrimoxazole, which can keep them healthy until you know for sure whether or not they have HIV.
A positive viral test means your baby has HIV. Finding out your baby has HIV can cause all kinds of feelings — sadness, worry, anger, or even numbness. Support offered by the health worker or the person you have with you can help.
Children — and parents — can live long and good lives with help from ART medicines, good food, and support from their community. The sooner you and your baby get on medicines for treatment, the better you both will be. More information on medicines for HIV is in Chapter 11.
If viral tests are not available at your health facility, you should have the child tested again with the antibody test after some months have passed. In the meantime, you can protect the baby’s health:
- Take your ART faithfully, especially if you are breastfeeding.
- Give the baby medicines, such as cotrimoxazole, to prevent illness.
- Feed your baby well and give him lots of loving attention.
- Watch for signs of illness and respond or seek help quickly if needed.
For more ways to protect your baby’s health, see Chapter 10: How to keep children healthy.
If your baby has a negative test
A negative viral or antibody test almost always means the baby does not have HIV. The health worker can give you information on how to keep yourself and your child healthy. Ask any questions you may have. Your child may need to be tested again, for example, after you stop breastfeeding.
Breastfeeding and HIV testing
If you have HIV and plan to breastfeed, your baby may still be exposed to HIV. Babies should be tested again 6 to 12 weeks after they stop breastfeeding. But if your HIV is well controlled by your ART, it is very unlikely your baby will become infected with HIV from breastfeeding. For more about breastfeeding safely when you have HIV, see Chapter 9.
Testing a child 18 months or older
To test a child 18 months or older for HIV, health workers use the same tests used to test adults.
Before the test, tell your child that the health worker will clean the spot where she will take the blood, and hold his hand palm up to prick his finger. After taking a few drops of blood for the test, she may put on a small bandage. Promise to stay close and say that it will hurt for only a few seconds, but you will have to wait for the test results, usually about 20 minutes.
If your child is old enough to understand what you and the health worker say, you will probably want to discuss the test result without the child at first. This will give you a chance to ask questions, talk about how much your child can understand, and discuss how to explain the result to him.
If the child has a positive test
A child older than 18 months who is no longer breastfeeding and who has a positive HIV test almost always has HIV. The health worker or counselor will give you this information, and will support you as you have your feelings and think of questions and concerns.
You will be better able to support your child if you take the time you need to let your feelings come out. Accept support from the health worker or the person you brought with you to the test. Discuss your concerns and questions with the health worker, and talk about what to tell your child.
If you do not know your own status, you should be tested yourself
Help your child understand the positive test
Think about how to talk with your child in ways that fit his age. A very young child may just need to know that he must take medicine every day to stay healthy. Older children will need and want more information. A child who already knows about HIV may be worried about having HIV, even if you do not tell him he has it. If you can be open with him, he will feel less alone.
Telling your child he has HIV may feel difficult. But it is usually better for both of you if you can start thinking about how to be more open about HIV, especially as the child grows. When children know more, they understand more and can participate more in their own care. It can also prevent problems later. Children older than about age 10 do not like to find out that information was kept from them. Children living away from their families need to know who they can talk to and get support from there. See Chapter 5 for how to talk with children about HIV.
Your child may be able to tell if you are sad or afraid. It is OK to be sad with your child if you can talk with him about it. It can help if you are calm and give a simple explanation of what the test result means for the child and your family.
If the child has a negative test
A negative test means your child most probably does not have HIV, as long as he has not recently been breastfed, or exposed to HIV in some other way, such as sexual abuse or possible blood contact. A child who had a recent exposure should be tested again in 6 weeks or 8 weeks. A negative test then means he definitely does not have HIV.
Tell your child his test results. Encourage him to ask questions.