Blood contact and daycare

My wife has contacted you before about her own HIV concerns, which I thought at the time were slightly ridiculous, but I do have some concerns about our kid and could use your expertise.

Our 7 month old is in a daycare 9 hours a day. I became concerned about HIV when another child bit her on Thursday. I spent a few hours there Friday to watch over her and make sure she was ok and saw a bunch of situations involving blood that led to the following questions.

What is the chance of my kid getting HIV from a small bite from another child with HIV?

What are the chances of HIV infection if another child who has HIV and is teething and has bleeding gums grabs my kid's bottle and puts it in their mouth, blood gets on the bottle, and seconds later my kid grabs it back and drinks from it?

What are the chances of HIV infection if another child who has HIV has a bloody nose and bleeds on a toy which my child puts in his mouth seconds or minutes later?

Any issues with the daycare staff to be concerned about, specifically if they had a small cut and touched the toys, bottles or kids' mouths?

Appreciate your response. In this economy we both have to work, and are lucky to have jobs at all. The daycare we can afford is not in the best area but I want to make sure I'm not putting my kid in danger.

[H. Hunter Handsfield, M.D.]

Relax.  No risk to speak of.

By regulations that apply in most if not all states, day care facilities are supposed to be on the lookout to prevent blood-borne infections like hepatitis B and HIV, primarily by preventing injuries and, if one occurs, properly cleaning up any blood before other kids are at risk.  Fortunately, such infections are rarely if ever transmitted by biting, and not through saliva and other body secretions.  (Even swallowing HIV infected blood carries little risk.)  The risk is also low because there are so few HIV infected young kids in the US these days.  I'll bet there has not been a single case of HIV in a child acquired in day care in the US in the past 10 years.

There are, of course, real infection risks in day care, or in any other setting where young children are placed together in signficant numbers. You can be sure your child will catch colds and norovirus (the main cause of 1-2 day bouts of vomiting and diarrhea) in day care, probably a couple times a year if not more.  Tuberculosis, hepatitis A, strep throats, influenza, molluscum congatiosum, herpes due to HSV-1, all the common childhood diseases, and a number of others all are more frequent in such children -- and in their family members at home -- than in kids who don't go to day care.  Day care facilities in most if not all states operate under regulations that require standard precautions to attempt to reduce these risks, and known infected kids are to be kept at home.  But as you can imagine, these measures reduce but do not eliminate the risks.

For all these reasons, feel free to discuss infection control with day care manager.  Be on the lookout for all the garden variety infections.  But don't worry about your child catching HIV.  (And by the way, don't ask whether there are any HIV infected kids attending.  They won't know, and if they do, it is against the law to reveal it.)

I hope this helps.  Best wishes--  HHH, MD

[newdad72]

Many thanks. One final question, if my kid put anything in his mouth with blood on it, say 5-10 minutes later so the. blood was at least starting to dry, is there any hiv risk? He has a habit of picking stuff up off the floor and putting it in his mouth, not just at daycare but everywhere we go. I worry as he is just starting to start teething.

[H. Hunter Handsfield, M.D.]

As explained in my original reply, your child is not at risk for catching HIV in day care -- period.  The biological reasons for that fact really don't matter.  Nobody ever catches HIV this way.  

Everybody concerned about catching HIV in the environment asks the drying question.  The more blood dries, the more HIV will be inactivated, but there are no hard and fast limits.  Anyway, getting even fresh blood in large amounts into the mouth rarely if ever transmits HIV, and whether or not a child is teething is unlikely to make any difference either.

You came here for reassurance.  I gave it.  Please accept it and move on.  That will be all for this thread.