Clinical Reference Systems: Pediatric Advisor 10.0
- multiple small, red bumps that become thin-walled water
blisters; then cloudy blisters or open sores; and finally
dry, brown crusts (all within 24 hours)
- repeated crops of these sores for 4 to 5 days
- sores or crusts that are usually less than 1/4 inch
- rash that is on all body surfaces, but usually starts on
head and back
- some sores possibly in the mouth, eyelids, and genital
- fever (unless the rash is mild)
- exposure to a child with chickenpox 14 to 16 days
Chickenpox is caused by exposure to a highly contagious
A chickenpox vaccine is now available. Most physicians
recommend this vaccine for all children who haven't had
chickenpox. It can be given at any time after 12 months of
age. Children up to 12 years old need just a single
injection. Two injections 4 to 8 weeks apart are
recommended for adolescents over 12 years and adults who
have never had chickenpox.
New eruptions continue to crop up daily for 4 to 5 days.
The fever is usually the highest on the third or fourth day.
Children start to feel better and stop having a fever once
they stop getting new bumps. The average child gets a total
of 500 chickenpox sores.
Chickenpox rarely leaves any permanent scars unless the
sores become badly infected with impetigo or your child
repeatedly picks off the scabs. However, normal chickenpox
can leave temporary marks on the skin that take 6 to 12
months to fade. One attack usually gives lifelong immunity.
Very rarely, a child may have a second mild attack.
- Itching and cool baths
The best treatment for skin discomfort and itching is a
cool bath every 3 to 4 hours for the first few days.
Add 2 ounces (4 tablespoons) of baking soda per tub of
water. Baths don't spread the chickenpox. Calamine
lotion can be placed on the most itchy spots after the
bath. You can also massage the itchy spots with an ice
cube for 10 minutes. If the itching becomes severe or
interferes with sleep, give your child a nonprescription
antihistamine called Benadryl.
Acetaminophen or ibuprofen may be given in the dose
appropriate for your child's age for a few days if your
child develops a fever over 102ƒF (39ƒC). Do not give
aspirin to children and adolescents with chickenpox
because of the link with Reye's syndrome.
- Sore mouth
Because chickenpox sores also occur in the mouth and
throat, your child may be picky about eating. Encourage
your child to drink cold fluids. For infants, use a cup
rather than a bottle because the nipple can cause pain.
Offer a soft, bland diet and avoid salty foods and
citrus fruits. If mouth sores become troublesome and
your child is over age 4, have him gargle or swallow
1 teaspoon of an antacid solution four times a day after
- Sore genital area
Sores also normally occur in the genital area. If
urination becomes very painful, apply some 2.5%
Xylocaine (no prescription needed) to the genital ulcers
every 4 hours to relieve pain.
Acyclovir is an oral, anti-viral drug that can be used
to treat chickenpox. It helps only if started within
24 hours of the appearance of the first sores.
According to recent research, acyclovir has mild
benefits: it reduces the number of sores by 20% and the
days of illness by one. The complication rate is not
reduced. If used, acyclovir needs to be taken for
5 days. The cost is $30 to $50. The drug has few
reported side effects.
Which children with chickenpox should receive acyclovir
is a controversial topic. Physicians do agree that all
children who have immune system defects, are taking
steroids, or have a chronic skin or lung disease should
receive acyclovir. Some physicians prescribe acyclovir
for adults, college students, and high school students.
Some also prescribe it for younger children who have
social obligations (such as travel). Most physicians
don't treat normal, healthy children with acyclovir.
- Prevention of impetigo (infected sores)
To prevent the sores from becoming infected with
bacteria, trim your child's fingernails short. Also,
wash the hands with an antibacterial soap (such as Dial
or Safeguard) frequently during the day. For young
babies who are scratching badly, you may want to cover
their hands with cotton socks.
- Contagiousness and isolation
Children with chickenpox are contagious until all the
sores have crusted over, usually about 6 to 7 days after
the rash begins. To avoid exposing other children, try
not to take your child to the physician's office. If
you must, leave your child in the car with a sitter
while you check in. Once all the sores have crusted
over (after 6 to 7 days), your child does not have to
stay home anymore even though he still has scabs. It
may take 2 weeks for all of the scabs fall off.
Most adults who think they didn't have chickenpox as a
child had a mild case. Only 4% of adults are not
protected. If you lived in the same household with
siblings who had chickenpox, consider yourself
protected. Siblings will come down with chickenpox in
14 to 16 days. The second case in a family always has
many more chickenpox sores than the first case.
Call Your Child's Physician Immediately If:
- Some chickenpox sores look infected (yellow pus,
spreading redness, red streaks).
- Your child develops a speckled, red rash.
- Your child starts acting very sick.
Call Your Child's Physician Within 24 Hours If:
- A scab looks infected (becomes larger or drains pus).
Note: Use an antibiotic ointment on these sores until
your child is seen by a physician.
- The fever lasts over 4 days.
- The itching is severe and doesn't respond to treatment.
- You have other concerns or questions.