Chickenpox (Varicella)

Chickenpox is a disease caused by a virus. It is highly contagious. If your child has chickenpox, then your child was exposed to the virus 14 to 16 days earlier.

Symptoms of chickenpox include:

• 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 across 
• rash that is on all body surfaces, but usually starts on head and back 
• some sores possibly in the mouth, eyelids, and genital area 
• fever (unless the rash is mild).

New sores will 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. It may take 2 weeks for all of the scabs to fall off.

Chickenpox rarely leaves any permanent scars unless the sores become badly infected 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. Once a child has had chickenpox he will usually never get it again. Very rarely, a child may have a second mild attack of chickenpox.

• Itching and cool baths 
  The best treatment for skin discomfort and itching is a cool or lukewarm bath every 3 to 4 hours for the first few days. Add 2 ounces (4 tablespoons) of baking soda, oatmeal, or cornstarch per tub of water. Baths don't spread the chickenpox. Put calamine lotion on the 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 pill called Benadryl.
   
• Fever 
  Acetaminophen may be given in the dose appropriate for your child's age for a few days if your child develops a fever over 102°F (39°C). Do not give ibuprofen products because of a possible link with severe Strep infections. 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 meals.
   
• Sore genital area 
  Sores also normally occur in the genital area. If urination becomes very painful, apply some 2.5% lidocaine (Xylocaine) or pramoxine (no prescription needed) to the genital ulcers every 4 hours to relieve pain.
   
• Acyclovir 
  Acyclovir is a prescription antiviral drug sometimes used to treat chickenpox. It helps only if started within 24 hours after sores appear. It slightly reduces the number of sores and may shorten the days of illness by one. Most normal, healthy children do not need to take this drug. Children who have immune system problems, are taking steroids, or have a chronic skin or lung disease should receive acyclovir. It may also be prescribed for adults, college students, and high school students.
   
• Prevention of 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 5 days before the rash begins and until all the sores have crusted over, usually about 5 to 7 days after the rash begins. To avoid exposing other children, try not to take your child to the healthcare provider'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 5 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.

A chickenpox vaccine is now available. Most healthcare providers 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.

If you feel that your child needs immediate medical care.

• Some chickenpox sores look infected (yellow pus, spreading redness, red streaks). 
• Your child develops a speckled, red rash. 
• Your child starts acting very sick.

• A scab looks infected (becomes larger or drains pus). Note: Use an antibiotic ointment on these sores until your child is seen by a healthcare provider. 
• The fever lasts over 4 days. 
• The itching is severe and doesn't respond to treatment. 
• You have other concerns or questions. If you take your child to a doctor's office, call ahead to let the staff know that you think your child has chickenpox.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.