Telling an HIV-infected Child of His Diagnosis

I am following a family where both parents and a child are HIV-
infected. The child is now 8-years-old. The parents have not
informed the child of his diagnosis. When is the most appropriate
time to tell an HIV-infected child of his diagnosis?

The Committee on Pediatric AIDS of the American Academy of
Pediatrics recommends disclosure of the diagnosis to all HIV-
infected children in an age appropriate manner. Younger children
should receive simple explanations about HIV, and as the child ages
and becomes more mature, explanations can become more detailed.
Experience has demonstrated that children who are fully aware of
their condition from an early age often cope better with their
illness, and understand that the disease and its treatment are just
part of their daily lives.

Parents sometimes are reluctant to disclose a diagnosis of HIV even
to older children. Reasons for this reluctance include fear of
disclosure of the diagnosis by the child to others in the community,
concern that the child will become depressed or give up hope when
made aware of the diagnosis, and feelings of guilt over the way in
which the child acquired the infection. It is important to discuss
issues surrounding disclosure of the diagnosis with the parents in a
non-judgmental way, acknowledging that they are uniquely suited to
understand the implications of disclosure for their child. If the
parents decide that they are not ready for disclosure of the
diagnosis to the child, the health professionals should revisit the
topic again in three or six months. It is important that the health
care team convey a consistent message regarding the importance of
disclosure, as well as their support for the parents and family in
working through this difficult decision.