Chicken pox rash in toddlers
Chickenpox - Symptoms and causes
Overview
Chickenpox
Chickenpox
Chickenpox consists of an itchy, red rash that breaks out on the face, scalp, chest, back and, to a lesser extent, arms and legs. The spots quickly fill with a clear fluid, rupture and then turn crusty.
Chickenpox is an infection caused by the varicella-zoster virus. It causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. Today, a vaccine is available that protects children against chickenpox. Routine vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC).
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.
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Symptoms
The itchy blister rash caused by chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. Other signs and symptoms, which may appear one to two days before the rash, include:
- Fever
- Loss of appetite
- Headache
- Tiredness and a general feeling of being unwell (malaise)
Once the chickenpox rash appears, it goes through three phases:
- Raised pink or red bumps (papules), which break out over several days
- Small fluid-filled blisters (vesicles), which form in about one day and then break and leak
- Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days, so you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. You can spread the virus to other people for up to 48 hours before the rash appears, and the virus remains contagious until all broken blisters have crusted over.
The disease is generally mild in healthy children. In severe cases, the rash can cover the entire body, and lesions may form in the throat, eyes, and mucous membranes of the urethra, anus and vagina.
When to see a doctor
If you think you or your child might have chickenpox, consult your doctor. He or she usually can diagnose chickenpox by examining the rash and considering other symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. To avoid infecting others in the waiting room, call ahead for an appointment and mention that you think you or your child may have chickenpox.
Also, let your doctor know if:
- The rash spreads to one or both eyes.
- The rash gets very red, warm or tender. This could indicate a secondary bacterial skin infection.
- The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 102 F (38.9 C).
- Anyone in the household has a problem with his or her immune system or is younger than 6 months.
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Causes
Chickenpox infection is caused by the varicella-zoster virus. It can spread through direct contact with the rash.
It can also spread when a person with the chickenpox coughs or sneezes and you inhale the air droplets.
Risk factors
Your risk of becoming infected with the varicella-zoster virus that causes chickenpox is higher if you haven't already had chickenpox or if you haven't had the chickenpox vaccine. It's especially important for people who work in child care or school settings to be vaccinated.
Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. A few people can get chickenpox more than once, but this is rare. If you've been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever.
Complications
Chickenpox is normally a mild disease. But it can be serious and can lead to complications including:
- Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis)
- Dehydration
- Pneumonia
- Inflammation of the brain (encephalitis)
- Toxic shock syndrome
- Reye's syndrome in children and teenagers who take aspirin during chickenpox
- Death
Who's at risk?
People who are at higher risk of chickenpox complications include:
- Newborns and infants whose mothers never had chickenpox or the vaccine
- Adolescents and adults
- Pregnant women who haven't had chickenpox
- People who smoke
- People whose immune systems are weakened by medication, such as chemotherapy, or by a disease, such as cancer or HIV
- People who are taking steroid medications for another disease or condition, such as asthma
Chickenpox and pregnancy
Low birth weight and limb abnormalities are more common among babies born to women who are infected with chickenpox early in their pregnancy.
When a mother is infected with chickenpox in the week before birth or within a couple of days after giving birth, her baby has a higher risk of developing a serious, life-threatening infection.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.
Chickenpox and shingles
If you've had chickenpox, you're at risk of a complication called shingles. The varicella-zoster virus remains in your nerve cells after the skin infection has healed. Many years later, the virus can reactivate and resurface as shingles — a painful cluster of short-lived blisters. The virus is more likely to reappear in older adults and people who have weakened immune systems.
The pain of shingles can last long after the blisters disappear. This is called postherpetic neuralgia and can be severe.
The shingles vaccine (Shingrix) is recommended for adults who have had chickenpox. Shingrix is approved and recommended for people age 50 and older, including those who've previously received another shingles vaccine (Zostavax).
Zostavax, which isn't recommended until age 60, is no longer sold in the United States.
Prevention
The chickenpox (varicella) vaccine is the best way to prevent chickenpox. Experts from the CDC estimate that the vaccine provides complete protection from the virus for nearly 98% of people who receive both of the recommended doses. When the vaccine doesn't provide complete protection, it significantly lessens the severity of chickenpox.
The chickenpox vaccine (Varivax) is recommended for:
Young children. In the United States, children receive two doses of the varicella vaccine — the first between ages 12 and 15 months and the second between ages 4 and 6 years — as part of the routine childhood vaccination schedule.
The vaccine can be combined with the measles, mumps and rubella vaccine, but for some children between the ages of 12 and 23 months, the combination may increase the risk of fever and seizure from the vaccine.
Discuss the pros and cons of combining the vaccines with your child's doctor.- Unvaccinated older children. Children ages 7 to 12 years who haven't been vaccinated should receive two catch-up doses of the varicella vaccine, given at least three months apart. Children age 13 or older who haven't been vaccinated should also receive two catch-up doses of the vaccine, given at least four weeks apart.
Unvaccinated adults who've never had chickenpox and are at high risk of exposure. This includes health care workers, teachers, child care employees, international travelers, military personnel, adults who live with young children and all women of childbearing age.
Adults who've never had chickenpox or been vaccinated usually receive two doses of the vaccine, four to eight weeks apart. If you don't remember whether you've had chickenpox or the vaccine, a blood test can determine your immunity.
The chickenpox vaccine isn't approved for:
- Pregnant women
- People who have weakened immune systems, such as those who are infected with HIV, or people who are taking immune-suppressing medications
- People who are allergic to gelatin or the antibiotic neomycin
Talk to your doctor if you're unsure about your need for the vaccine.
If you're planning on becoming pregnant, consult with your doctor to make sure you're up to date on your vaccinations before conceiving a child.
Is it safe and effective?
Parents typically wonder whether vaccines are safe. Since the chickenpox vaccine became available, studies have consistently found it to be safe and effective. Side effects are generally mild and include redness, soreness, swelling and, rarely, small bumps at the site of the shot.
By Mayo Clinic Staff
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What Is Chickenpox?
Chickenpox is a viral infection that causes fever and an itchy rash with spots all over the body.
It used to be a common childhood illness in the United States, especially in kids under age 12. It's much rarer now, thanks to the varicella vaccine.
What Are the Signs & Symptoms of Chickenpox?
Chickenpox often starts without the classic rash, with a fever, headache, sore throat, or stomachache.
These symptoms may last for a few days, with the fever in the 101°–102°F (38.3°–38.8°C) range.
The red, itchy skin rash usually starts on the belly or back and face. Then it spreads to almost everywhere else on the body, including the scalp, mouth, arms, legs, and genitals.
The rash begins as many small red bumps that look like pimples or insect bites. They appear in waves over 2 to 4 days, then develop into thin-walled blisters filled with fluid. The blister walls break, leaving open sores, which finally crust over to become dry, brown scabs.
All three stages of the chickenpox rash (red bumps, blisters, and scabs) appear on the body at the same time. The rash may spread wider or be more severe in kids who have weak immune systems or skin disorders like eczema.
What Causes Chickenpox?
Chickenpox is caused by the varicella-zoster virus (VZV). This virus also can cause a painful skin rash called shingles (herpes zoster) later in life. After someone has had chickenpox, the virus stays dormant (resting) in the nervous system for the rest of their life.
The virus can reactivate ("wake up") later as shingles.
Kids who are vaccinated against chickenpox are much less likely to develop shingles when they get older.
Is Chickenpox Contagious?
Chickenpox is very contagious. Most kids with a sibling who's infected also will get it (if they haven't already had the infection or the vaccine), showing symptoms about 2 weeks after the first child does.
Someone with chickenpox can spread the virus:
- through droplets in the air by coughing or sneezing
- in their mucus, saliva (spit), or fluid from the blisters
Chickenpox is contagious from about 2 days before the rash starts until all the blisters are crusted over.
Someone with shingles can spread chickenpox (but not shingles) to people who haven't had chickenpox or the vaccine.
Because chickenpox is so contagious, a child who has it should stay home and rest until the rash is gone and all blisters have dried. This usually takes about 1 week.
If you're unsure about whether your child is ready to return to school, ask your doctor.
What Problems Can Happen?
Some people are more at risk for complications from chickenpox, including:
- pregnant women
- newborns born to mothers who had chickenpox
- patients with leukemia
- kids receiving medicines that suppress the immune system
- anyone with immune system problems
If they are exposed to chickenpox, they might be given a medicine (zoster immune globulin) to make the illness less severe.
Can Chickenpox Be Prevented?
Yes. Most people who get the chickenpox vaccine will not get chickenpox. And if they do get chickenpox, their symptoms will be much milder.
Doctors recommend that kids get the chickenpox vaccine as:
- a first shot when they're 12–15 months old
- a booster shot when they're 4–6 years old
People 6 years of age and older who have never had chickenpox and aren't vaccinated can and should get two doses of the vaccine.
Kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.
How Is Chickenpox Diagnosed?
Doctors usually can diagnose chickenpox by looking at the telltale rash.
Call your doctor if you think your child has chickenpox. The doctor can guide you in watching for complications and in choosing medicine to ease itching.
If you take your child to the doctor, let the staff know ahead of time that your child might have chickenpox. It's important not to expose other kids in the office — for some of them, a chickenpox infection could cause serious complications.
How Is Chickenpox Treated?
A
viruscauses chickenpox, so antibiotics can't treat it. But antibiotics are needed if bacteria infect the sores. This can happen when kids scratch and pick at the blisters.
An antiviral medicine might be prescribed for people with chickenpox who are at risk for complications.
The depends on the:
- child's age and health
- extent of the infection
- timing of the treatment
Your doctor can tell you if the medicine is right for your child.
How Can I Help My Child Feel Better?
To help relieve the itchiness and discomfort of chickenpox:
- Use cool wet compresses or give baths in lukewarm water every 3–4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)
- Pat (don't rub) the body dry.
- Put calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).
- Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
- Ask the doctor about using over-the-counter medicine to take by mouth for itching.
To prevent scratching:
- Put mittens or gloves on your child's hands to avoid scratching during sleep.
- Trim fingernails and keep them clean.
If your child has blisters in the mouth:
- Give cold, soft, bland foods because chickenpox in the mouth can make it hard to drink or eat. Avoid anything acidic or salty, like orange juice or pretzels.
- Give your child acetaminophen to help relieve pain.
Never give aspirin to kids with chickenpox. It can lead to a serious illness called Reye syndrome.
When Should I Call the Doctor?
Most chickenpox infections don't need special medical treatment. But sometimes, problems can happen. Call the doctor if your child:
- has a fever that lasts for more than 4 days
- has a severe cough or trouble breathing
- has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
- has a severe headache
- is very drowsy or has trouble waking up
- has trouble looking at bright lights
- has trouble walking
- seems confused
- is vomiting
- seems very ill
- has a stiff neck
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