1. Oral Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

2. Oral Problems  Oral problems are common in children with HIV  Often a sign that HIV disease is progressing  Type, frequency and severity of problems depend on the child ©TALC

3. Issues  Oral problems are commonly painful and distressing for a child  A child may refuse to drink or eat  Children are therefore at risk of dehydration and/or malnutrition  Early diagnosis and treatment is essential to prevent complications ©TALC

4. Oral Thrush  Common in children  Caused by candida infection  White patches on roof of mouth, inside cheeks, back of tongue or throat  May be very painful  May be in corners of mouth or in throat ©TALC

5. Oral Thrush  Pain is distressing for child  May be difficult to swallow  Child may not want/ be unable to eat or drink  May lead to dehydration and/or malnutrition  If severe, recurrent or in throat, suggestive of HIV ©TALC

6. Management of Oral Thrush  Wash hands  Wet a clean soft cloth with salt water and use to wash child’s mouth  Refer for: Daktarin oral gel (4-6 hourly x 7-14 days) and /or Nystatin 6 hourly  Try both if severe/persistent  If N/A, paint with Gentian Violet  Avoid feeding for 20 minutes after medication

7. Management of Oral Thrush  If breast fed, check mother’s breasts for thrush  If thrush present, treat breasts with nystatin or Gentian Violet  Advise mother to wash breasts after feeds  If bottle fed, change to cup and spoon ©TALC

8. Management of Oral Thrush  Ensure regular pain relief to relieve discomfort and encourage drinking/eating  Encourage small, frequent drinks and food to prevent dehydration & malnutrition

9. Management of Oral Thrush If thrush is no better / worse or swallowing is painful:  refer child to clinic for investigations & medication

10. Preventing Oral Thrush  Thorough washing of bottles, teats, cups, spoons  Daily Tooth brushing  Breastfeeding  Nutritious foods  Vitamins ©TALC

11. Herpes Simplex  Painful, small blisters or open sores on lips or in mouth  May also be around nose  May be accompanied by fever  Herpes >1 month = AIDS defining condition CDC/J.D.Millar

12. Herpes  May be very painful  Child may not want/be unable to eat or drink  May lead to dehydration or malnutrition  May last long time/recur  Can be spread from one person to another ©TALC

13. Management of Herpes  Paracetemol (Panado)  Encourage fluids  Hand Washing  Soft diet  Thorough cleaning of utensils

14. Management of Herpes  Refer for oral Acyclovir  May need IV Acyclovir if severe  May need antibiotics for secondary infection  Child needs clinic/ hospital urgently if: - Child is not drinking - Child is dehydrated - Signs of difficulty breathing, jaundice or behaviour change

15. Preventing Herpes  Nutritious Foods  Vitamins  Hand Washing  Avoid touching mouth  Avoid kissing if herpes present  Thorough cleaning of feeding implements and utensils

16. Mouth Ulcers  Painful blisters on tongue or in mouth  Size 2-3mm to 2-3 cm  Occur as single blister or in ‘clusters’  Occur on roof of mouth, tongue, inner cheek, tonsils  Child may be reluctant to eat or drink ©TALC

17. Management of Mouth Ulcers  Wash hands  Wet a clean soft cloth with salt water and use to wash child’s mouth  Paint mouth with Gentian Violet, twice daily  Continue using Gentian Violet until 48 hours after ulcers have been cured  Give Paracetemol for pain relief

18. Dental Problems  Inflammation of gums  Tooth abscesses  Painful  May not want to eat/drink  Secondary infection ©TALC

19. Managing Dental Problems  Daily Tooth Brushing  Water and Salt mouth wash  Chlorhexidine mouthwash  Dental checks  Antibiotic treatment

20. Preventing Oral Problems  Regular tooth brushing  Vitamins  Nutritious foods  Avoid sugary foods that will rot teeth  Encourage calcium

21. Managing Oral Problems  Encourage diet and fluids  Pain relief (Paracetemol)  Salt and water mouth wash  Gentian Violet  Chlorhexidine  Regular checks ©TALC