Your child will have a number of tests to see how HIV is affecting their health and development.

Looking at the results of these tests, you and your doctor will be able to decide on the best course of treatment for your child.

Every time your child sees his or her HIV doctor, they will have a physical examination to check on their health and development.

Your child will be weighed and measured to monitor their growth. It is known that HIV-positive children often have a slower rate of growth, and may enter puberty at a later age than HIV-negative children.

Looking at how alert or happy your child is will help the doctor assess his or her health.

A thermometer placed in the ear for a few seconds will be used to monitor temperature. A high temperature can indicate an infection that requires treatment.

The doctor will check for rashes and dry skin, both of which are common in children with HIV.

By gently pressing down on the stomach, the doctor will be able check for any abnormalities and problems with the internal organs.

The doctor will use an instrument to look into your child’s eyes, ears and throat. This isn’t painful, and you or the doctor may make a game of it to make it seem less threatening for your child.

A stethoscope will be placed against your child’s chest to check their breathing and heartbeat.

Regular blood tests are an essential part of care for everyone living with HIV.

A lot of adults don’t like having their blood taken, and children often find it a frightening and distressing experience.

But there are a number of things that can be done to make it less unpleasant.

The skin can be temporarily numbed by applying anaesthetic cream before the blood is taken.

Explaining what is happening, and distracting children from the procedure can help make the experience less frightening. Over time most children gain confidence about blood tests if they have had good experiences and their fears have been calmed. Most children’s clinics have specialist blood-taking teams who know how to help children with this.

After the blood has been taken, give your child a hug and congratulate him or her for being brave.

The key tests used to monitor HIV in children are:

• CD4 cell count
• viral load.

The CD4 cell count can give a rough indication of the health of the immune system, and viral load shows how active HIV is in the body.

Because children’s immune systems aren’t fully developed, their CD4 cell count and viral load are different from those in adults.

CD4 cell counts tend to be higher in young children than adults, but these stabilise as the child gets older.

In babies, viral load can rise to very high levels and only decline very gradually over the first few years of life.

Looking at the results of these tests can help doctors decide when your child should start treatment for HIV, when they may need treatment to prevent infections and to see how effective any HIV treatment is. There’s more information on treatment to prevent infections and starting and changing HIV treatment later in this booklet.

Your child will also have regular blood tests to monitor other aspects of health. For example, tests will look at how organs such as their heart, kidneys and liver are working and can check for anaemia or infections. Looking at the results of these tests, your child’s doctor will be able to see if any further investigation or treatment is needed.

It may sometimes be necessary for samples of your child’s urine, sputum or stools to be checked for infections.

Scans, X-rays and ultrasounds are used to help diagnose some health conditions. They are not painful, but as a new experience for a child and they might be unsettling.

There’s more information on tests regularly used in the care of people with HIV in NAM’s booklet CD4, viral load & other tests. Although it is a guide to the medical monitoring of HIV-positive adults, much of the information also applies to the care of HIV-positive children.