Chickenpox in Children & Teens

Symptoms of Chickenpox

The chief symptom of chickenpox is a rash. However, one or two days before the rash appears, some children develop a fever, which may be accompanied by headache, malaise, and/or a lack of appetite. It is important that you never give aspirin to children for fever. The combination of aspirin or aspirin-like drugs (salicylates) and the chickenpox virus is associated with an increased risk of Reye’s syndrome, a rare but potentially fatal liver and brain illness.

When the rash appears, it typically goes through several stages:

• Splotchy, red spots (pox) or pimples appear and, over the first few days, progress to small, fragile, fluid-filled blisters on top of an itchy, red rash.
• Over a period of about seven days, the blisters erupt and form a scab or crust; at this stage there may be intense itching.
• The rash often begins on the face or trunk and then spreads over the extremities in successive waves. Spots may also spread to the mouth, vagina, anus, or ears.
• There may be only a few sores or hundreds. Rashes at varying stages of eruption and healing may be present at the same time. When all the blisters have scabbed, the scabs may last for another week.
• Any fever generally subsides once the rash has reached the scab stage.

What Is Chickenpox?

Chickenpox is a very common, highly contagious disease that is usually mild in its course, which is marked by fever and a characteristic itchy rash. More than 90 percent of cases occur in children younger than nine years of age. Outbreaks are common among children in a household and in schools and day-care centers, often during the winter and spring.

Most adults have been exposed to chickenpox as children and, with rare exceptions, possess lifelong immunity to the disease. But unexposed adults are susceptible, and those who do get chickenpox generally have more severe symptoms and are at greater risk of complications than children.

What Causes Chickenpox?

Chickenpox is caused by a form of herpes virus called Varicella zoster. The virus is easily and rapidly spread from person to person through exposure either to cells from the skin lesions that are suspended in air or droplets from the mouth or nose.

A child who first shows symptoms is infectious for a week or so, beginning about a day before a rash appears and continuing until all the pox have dried up. Once the virus has been transmitted to a susceptible child, it will incubate in the body for 10 to 23 days before symptoms appear.

After lesions heal, the Varicella zoster virus remains inside the body in a latent (inactive) form. Many years later the virus may become reactivated, causing the painful ailment shingles (Herpes zoster), which occurs in about 20 percent of people who have had chickenpox.

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What if You Do Nothing about Chickenpox?

The rash may be uncomfortable, but most cases of chickenpox clear up without complications in 10 to 14 days—though some scabs may take up to 20 days to heal. The scabs may leave behind light scars, but these will fade.

One possible complication is a secondary bacterial infection of the skin. Infection with Group A Streptococci, for example, can spread through cracks in the skin and invade the body, causing potentially life-threatening disease.

Those with cancer or compromised immune systems may take a longer time to heal and are at greater risk of serious complications, including pneumonia or brain infections.

Pregnant women who have never had chickenpox should avoid anyone with the disease: in rare cases chickenpox in pregnant women damages the fetus. Newborns should also be kept away from those with the disease. Chickenpox in newborns can be quite severe and is sometimes fatal—although most infants possess protective maternal antibodies against the illness.

Home Remedies for Chickenpox

There is no cure for chickenpox, but you can relieve the symptoms. Remember to never give children aspirin for lowering fever. Also be aware that many over-the-counter remedies, including herbal preparations, contain aspirin. To reduce fever and relieve aches in children, use acetaminophen instead.

• Plenty of rest is helpful. Children need not be kept in bed constantly, but their activity should be limited.
• Relieve itching. Dab calamine lotion on affected areas twice a day with sterile gauze. Over-the-counter antihistamine creams may also help, as can cool baths. Add a handful of ground instant or colloidal oatmeal (available in pharmacies), or a half a cup of baking soda or cornstarch, to the bath water. Pat, don’t rub, the skin dry.
• Keep skin clean. Sponge baths a few times a day will also help to keep scabs and blisters clean and free of infection. Have infected children wash their hands frequently with antibacterial soap.
• Don’t scratch. Scratching can cause blisters to become infected, leading to permanent scarring. Cut a child’s fingernails short. Gloves or mittens may be worn to prevent scratching during sleep.
• Gargle with salt water. If blisters have formed in the mouth, a salt water gargle (a half teaspoon of salt per cup of water) may bring relief.

Prevention of Chickenpox

Get vaccinated. A safe and effective chickenpox vaccine is available. It is recommended for children a year old or older who are in good health, and for adults who have never had the disease. A single dose is given to children 1 to 12 years of age. Adolescents and adults get two doses four to eight weeks apart.

Avoid infecting others. A child with chickenpox should stay home at least until all scabs have dried completely—at which point the infection won’t be spread. (This applies to infected adults as well.)

Friends, playmates, or schoolmates—indeed, anyone who has come in contact with the infected person in the preceding few days—should be informed about the situation. Susceptible adults, especially pregnant women, should take care to avoid contact with anyone infected—and newborns should be kept away. Children can return to school once the last blisters have crusted over.

When To Call Your Doctor about Chickenpox

Call your doctor to confirm the diagnosis. A description of the rash is usually sufficient to determine that the illness is chickenpox. Avoid visiting the doctor’s office, where others could catch the infection, unless your doctor tells you to come in. Routine chickenpox in otherwise healthy children is best treated at home.

Call the doctor at once if there are convulsions, a stiff neck, severe headaches, listlessness, confusion, or rapid breathing. These may be signs of a brain infection or pneumonia, which require immediate medical attention.

Call your physician if blisters have become infected (red and oozing pus) or have spread to the eye area; also call if fever exceeds 102˚F, persists for more than four days, or is accompanied by a sore throat.

Pregnant women and newborns who develop symptoms should be seen by a doctor at once.

What Your Doctor Will Do

If itching is severe, your doctor may prescribe an oral or topical antihistamine. Antibiotics will be prescribed if a secondary infection develops. Some patients may also be treated with an antiviral drug (acyclovir), which helps to reduce the severity and shorten the course of illness.

Pregnant women and newborns who become infected may be treated with immune-boosting agents as well as acyclovir. Drugs may also be needed for lesions that are affecting the eye area to prevent damage to vision.

For More Information

• American Academy of Pediatrics

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