How children help parents at home. Mom, at the desk! How to teach parents to help their child with homework

The main method for diagnosing HIV infection is to detect antibodies to the virus in the blood using an enzyme-linked immunosorbent assay (ELISA), which has a sensitivity of about 99%. This method is screening. However, in normal practice, when using ELISA, false-positive and false-negative reactions often appear. In this regard, if a positive result is found, the analysis in the laboratory is carried out twice, and when at least one more positive result is obtained, blood serum is sent for a specific confirmatory test. For this, the method of immune blotting (IB) is used, in which antibodies to certain HIV-specific proteins are detected, even the remains of the virus envelope are detected.

Another diagnostic method is the polymerase chain reaction to HIV (PCR), which determines the number of copies of RNA of immunodeficiency virus in blood plasma. In fact, this method is quantitative (it measures the viral load) and is of great importance for determining the further prognosis and severity of HIV infection.

All diagnostic methods used are quite expensive and, as a result, not all laboratories conduct these tests, especially in small cities. Therefore, if HIV is suspected, several screening tests should be performed at intervals of 3-6 months. At the same time, it is necessary to observe the absence of AIDS-indicative diseases characteristic of people with impaired, weakened immunity, and, as a rule, not found in ordinary children. It is believed that if positive serological reactions are detected for more than 15 months, then this indicates the presence of HIV infection in the child. If a child older than 18 months does not have AIDS-related illnesses and there are no positive laboratory tests for HIV, then such a child is considered uninfected.

Children whose HIV-infected mothers passively passed HIV antibodies to them are considered conditionally ill. This condition, according to the International Classification of Diseases (ICD-10), is referred to as a non-conclusive HIV test.

These children make up the majority of children born to HIV-infected mothers. With the growth of the child, maternal antibodies are destroyed and, usually after 2 years of age, almost all laboratory tests for HIV infection are negative. In Moscow, such children, upon reaching 3 years of age, are deregistered.

Currently developed methods of treatment and prevention of HIV. Despite the fact that modern medicine is not yet able to completely rid (cure) the body of viruses, it allows you to extend the asymptomatic stage of HIV infection for a fairly long time. With the regular use of medicines, a person can lead an almost unlimited life, but at the same time he must remember the possibility of infection of other people. Russian treatment regimens for HIV-infected patients today are almost completely consistent with international standards. And if a pregnant HIV-infected woman complied with all the recommendations for prevention, then the risk of transmission of the infection to the child is reduced to 2-5%. Cases of the birth of healthy children from both HIV-infected parents are known.

Hepatitis B and C

Today, the frequency of infection with such infections as viral hepatitis B and C has increased in our country. Like HIV, hepatitis is hemocontact and have almost the same infection pathways. It should be noted that unlike HIV, infection with hepatitis B and C viruses is much easier. This is due to the higher resistance of the virus in the environment and the lower dose necessary for infection. Viral hepatitis refers mainly to chronic infectious diseases, often ending with the development of liver cirrhosis with the possible development of hepatocellular carcinoma (liver tumor).

For the fetus, the risk of hepatitis is significantly higher compared with HIV infection, and can reach up to 90%. Infection is possible with the carrier of the virus by the mother, and can occur transplacentally (through the placenta) or during childbirth. The incubation period (the time elapsing from the first contact with the pathogen to the appearance of the first signs of the disease) is on average 2-6 months, but with the transmission of the hepatitis pathogen through the blood (via blood transfusion), it can be reduced to 1.5 months.

A specific diagnosis of the disease is the determination of virus markers in the blood serum. The most common is to find the surface antigen of hepatitis B virus - HBsAg, which can be determined long before the onset of the disease. Not so long ago, hepatitis C virus antigen, HCV, was also determined.

An auxiliary diagnosis is based on monitoring the activity of liver cell enzymes (AST, ALT, etc.) in a biochemical blood test.

The prognosis of the development of the disease depends on the severity of the disease and the presence of complications. According to a number of studies, 30% of children born to mothers who carry hepatitis B virus develop cirrhosis in the future.

Today, the most effective measure to prevent the incidence of hepatitis B is vaccination. Hepatitis B vaccination has been included in the Russian national vaccination schedule since 1997. It is planned to vaccinate all children of the first year of life, and children from mothers - carriers of the virus and patients with hepatitis B begin to vaccinate already in the hospital.

Often you have to deal with a situation when a pregnant woman has a whole range of diseases. This is the most difficult case. If the mother used intravenous drugs, she often has a combination of viral hepatitis and HIV infection. If a woman had an erratic sex life, then a combination of HIV with syphilis and other sexually transmitted infections is possible. Persons with an antisocial lifestyle (alcohol abusers, taking drugs and having an erratic sex life) are many times more likely to become infected with dangerous diseases, including syphilis and HIV infection, and, consequently, the possibility of transmitting these diseases to offspring. In addition to all its negative social consequences, narcotic and alcohol-containing substances negatively affect the body, inhibiting it, and, moreover, extremely negatively affect the development of the fetus. In addition, the chronic diseases of a pregnant woman, especially inflammatory diseases of the pelvic organs, play a negative role for the health status of the unborn child. Intrauterine hypoxia of the fetus develops, which leads to a violation of the formation of the nervous system, prematurity and the manifestation of many other health deviations in the newborn. Some of these problems may remain for the rest of the child’s life.

I would like to note that for all its many problems, the healthcare system copes very well with the tasks assigned to it. One of the main factors that negatively affect the final result is the person’s attitude to his health. After all, the well-known phrase that the disease is easier to prevent than to cure is not filled with empty meaning. And this fully applies to the possible prevention of diseases of a newborn baby. If all expectant mothers regularly attended antenatal clinics during pregnancy, then if positive results for infectious diseases were found in the analyzes of the studies, it would be possible to start treatment and prevention, which would minimize the risk of transmission of the infection to the newborn. Unfortunately, this does not always happen, and often the first link in the diagnosis of a child’s disease is the maternity hospital.

The further path of a child without parental care lies through the children's department of the hospital to the orphanage. such children are possible from any of the institutions listed above. Having carefully studied all medical statements (sometimes very mean), you can get an idea of \u200b\u200bthe child’s health status. On the basis of such data, the "Medical opinion on the child being issued for adoption" is based to a greater extent.

The first and most basic way to begin the study of a child’s health status is his diagnosis. Next, you should carefully study the results of laboratory tests and, in the absence of such or their long term, it is necessary to conduct repeated studies.

It is advisable to pay attention to data on relatives (if any). It is generally accepted that the older the biological parents of the child (especially his mother), the higher the risk of hereditary diseases. The probability of having a healthy baby increases if the mother is in good health. However, it cannot be said that a woman with a health problem will certainly give birth to an infant with any form of pathology.

For a layman, when studying medical documentation, one should be guided by simple worldly logic. So, the more the child received medications, the more he had health problems. And, for example, the fact that the child is not vaccinated with all vaccinations that are appropriate for their age can also lead to various conclusions.

All children in the children's homes should undergo a medical examination twice a year, which requires the participation of medical specialists. The goal of the medical examination is to detect as early as possible deviations in the child’s health, which can lead to diseases. If signs of the disease are detected, measures are taken to establish the correct diagnosis. If necessary, the child is transferred to specialized departments of the hospital, clinic or clinic of scientific institutes, where he undergoes a full examination and begins to receive the necessary treatment or recommendations for further examination. When the diagnosis is finally determined, the child is registered with a specialist doctor, or in a specialized medical institution. So, in case of detection of HIV infection, in Moscow the child is registered with the Moscow City Center for AIDS Control and Prevention.

If the future parents are for some reason not satisfied with the result of the medical report on the health of the adopted child, then they have the right to an independent medical examination.

Dry phrases in medical documents can impress future adoptive parents about the futility of adopting a child. In such a situation, one should not give in ahead of time. First of all, it is necessary to talk with the doctors under whose supervision such a child is. A doctor who knows a specific baby can objectively assess the prospects, as well as give advice on further treatment. The vast majority of medical workers do not embellish the picture with the goal of "selling stale goods." Although the risk of developing further diseases remains, one should not immediately abandon the possibility of adopting such children. Indeed, a huge number of parents ("normal" in the understanding that they do not abandon and do not abandon their children) throughout the country raise their babies, successfully engaged in addition to their treatment.

Medicine does not stand still: today new diagnostic methods are constantly being developed, as well as (which is undoubtedly more important) new methods of treatment; new drugs are opening up that can completely cure even the worst diseases. More difficult is the treatment of diseases that have become chronic. In the treatment of infectious diseases, constant progress is observed, this applies more to bacterial diseases than to viral ones.

The main thing for future adoptive parents when searching for "their" baby is not to give in to the first impulse ("this is a sick child" or vice versa "I am crazy about this child"), but carefully consider all possible ways of the child’s development and weigh their strength. Most diseases of children today are successfully treatable. It is not necessary for adoption to wait for the final removal of the “terrible” diagnosis of a child registered with a specialist doctor (for example, a woman born to an HIV-infected woman), but you need to be prepared for additional difficulties arising from a lack of knowledge and misunderstanding of the people around you. And most importantly, it will be much easier for the child to cope with the problems that arise if he feels the support of loving parents.

Kreydich V.Yu.,
chief doctor of a specialized orphanage in Moscow

Infection leads to progressive damage to the immune defenses and the frequent development of opportunistic infections and cancer. For treatment, a combination of antiretroviral drugs is used.

General information about the development and pathophysiology of HIV infection in children is similar to that in adults, however, the method of infection, the clinical picture and treatment features are often different.

Infection in a child affects the whole family. In such cases, serological testing of siblings and parents is recommended. The doctor must provide the relatives of the sick child with all the necessary information and constantly advise them. The infected child must be taught the rules of hygiene and behavior in order to reduce the risk of transmitting the disease to others. When and how much a child talks about his illness depends on his age and maturity. Older children and adolescents should be aware of their diagnosis and the possibility of sexually transmitted infection; they should get all the necessary advice. The family may not want to turn to other people to diagnose the disease, as this can lead to social exclusion. Guilty feelings are common. Family members, including children, may develop depression, and they will need specialist advice. Since HIV infection is not transmitted through routine contacts that are common among children (for example, through saliva or tears), most HIV-infected children can attend school without restriction. There are also no reasons restricting the placement of such children in foster care, foster care or care for HIV-infected children. The presence of conditions that constitute an increased danger to others (for example, if a child bites aggressively or if he has open wounds with exudate that cannot be isolated) may require special precautions.

Epidemiology of HIV and AIDS in children

More than 90% of babies acquired the infection from the mother either before or during birth (vertical transmission). Most of the remaining children (including children with hemophilia or other blood clotting disorders) had the disease transmitted by blood transfusion. Several cases are the result of sexual abuse. For less than 5% of cases, the source of the disease is not established. Vertical transmission is now common to almost all new cases of HIV infection among adolescents. Among adolescents, the contingent of HIV-infected is represented by surviving children who got the disease as a result of vertical transmission, and people with a newly acquired infection (usually through sexual contact, especially homosexual between young men and men).

HIV infection was detected in about 2 million children; more than 370 thousand children become infected every year (14% of all new infections).

Disease transmission

The risk is greatest for children born to mothers who had seroconversion during pregnancy and women with progressive disease, low levels of CD4 + T cells, and prolonged rupture of membranes. In childbirth naturally, of the two twins, the first born is at greater risk than the second born, although this relationship may be unreliable for developing countries.

Caesarean section before active labor reduces the risk of MTCT. Nevertheless, it is obvious that MTCT is most significantly reduced when using antiretroviral therapy (including zidovudine)