American Academy of Pediatrics Committee on Infectious Diseases: Health guidelines for the attendance in day-care and foster care settings of children infected with human immunodeficiency virus.

As of Dec 2, 1986, there have been 27,704 adult cases of acquired immunodeficiency syndrome (AIDS) reported in the United States; death has been reported in 56% of these cases. In addition, 394 (1.4%) cases of AIDS have been reported in children younger than 13 years of age, with 240 deaths; 347 (88%) are less than 5 years old.’ Serologic testing has identified additional children in high-risk groups (eg, hemophiliacs) who have test results positive for human immunodeficiency virus (HIV; formerly called human T-cell lymphotropic virus type Ill/lymphadenopathy-associated virus [HTLV-III/LAV]) antibody and do not have recurrent or opportunistic infections. Because some of these children are of preschool age, a policy on the placement of HIV-infected children in day-care and foster care settings is required. Currently available data do not specifically address the risk of transmission of HIV in the daycare setting. Therefore, some recommendations presented in this paper are based on the unlikely, but hypothetical, possibility of transmission in this setting. Day care is defined in this statement as care provided in a place other than the child’s home in settings that include: family day care, group day care, day-care centers, day nurseries, nursery schools, Head Start programs, and other preschool programs in which attendance is not mandated by state law. The AAP2 guidelines for placement of HIV-infected children and adolescents in schools are applicable to children placed in legally required educational programs, including special education programs. Several factors increase the transmission of communicable diseases in child day-care settings.3’4 First, these children are in close physical contact with each other for extended periods of time. Second, young children exhibit handand objectmouthing behaviors that enhance the likelihood of their acquiring numerous infectious diseases. Third, toilet and hand-washing facilities may be inadequate for optimal hygienic practices, and the children’s use of available facilities is often less than ideal. In addition, children who attend daycare centers are at increased risk for acquiring some infections compared with children in family daycare settings where fewer children are present.