Definition

• Chickenpox is a viral rash all over the body
• It starts as small red bumps. The bumps change to clear and then cloudy blisters. The blisters change to open sores, and finally they scab over.

Health Information

Symptoms

• Chickenpox starts with some small water blisters or pimples on the head and back.
• Rash covers the entire body within a day.
• Chickenpox progress from tiny water blisters to dry brown crusts within 24 hours.
• Repeated crops of new chickenpox keep appearing for 4 to 5 days. Therefore, tiny blisters, sores and scabs are all present at same time.
• Sores (ulcers) can also occur in the mouth, on eyelids, and on genitals.
• Fever is most often present. The more the rash, the higher the fever.
• Main complication: skin infections from scratching.

Diagnosis

• Chickenpox can usually be diagnosed by how they look. Tests are not needed.
• Known contact with a child with chickenpox 10 - 21 days earlier helps.

Cause

• Chickenpox is caused by the Varicella virus

How It Is Spread

• From fluid inside the blisters and from respiratory secretions. Very contagious.
• Incubation period: 10-21 days.
• Contagious period: 6 or 7 days.

Prevention of Spread to Others

• Avoid all contact with other children until the sores have crusted over (7 days).
• Chickenpox can be prevented by getting the varicella vaccine.
• The vaccine has made it uncommon.

Care Advice

1. Overview:
   • Chickenpox is an unpleasant disease
   • Your job is to keep your child comfortable and to limit the itching.
   • Here is some care advice that should help.
2. Cool Baths For Itching:
   • For itching, give cool or lukewarm baths for 10 minutes as often as needed.
   • Caution: Avoid any chill.
   • Can add baking soda 2 ounces (60 ml) per tub.
   • Baths don’t spread the chickenpox.
   • Do not use soaps. Reason: Soaps cause dry skin and make the itch worse.
3. Calamine Lotion for Itching:
   • Put calamine lotion on the chickenpox that itch the most.
   • You can also rub an ice cube on the itchy spots for 10 minutes.
   • Don’t use any lotion containing Benadryl in it. Reason: It can be absorbed across the skin. Too much can cause side effects in kids.
4. Benadryl Medicine for Itching:
   • If itching becomes severe or interferes with sleep, give Benadryl by mouth.
5. Try Not to Scratch:
   • Try not to let your child pick and scratch at the sores. This can lead to infected sores.
   • Trim fingernails.
   • Wash hands often with soap.
6. Fever Medicine:
   • Give acetaminophen (such as Tylenol) for fever above 102° F (39° C).
   • Note: lower fevers are important for fighting infections.
   • Never use aspirin. Reason: Risk of Reye syndrome.
   • Also, don’t use ibuprofen. Reason: May increase risk of bad strep skin infections.
7. Fluids and Soft Diet:
   • The mouth and throat ulcers are painful. Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also, avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
   • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
8. Liquid Antacid for Mouth Pain:
   • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time. Age: Use for children over 1 year old.
   • For children over age 6, can use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • For younger children age 1 to 6, put a few drops in the mouth. Or put it on with a cotton swab.
   • Caution: Do not use regular mouth washes, because they sting.
9. For Pain With Passing Urine:
   • For girls with painful genital ulcers, put petroleum jelly on them as needed.
   • For severe pain, use a numbing ointment such as 2.5% xylocaine ointment. No prescription is needed. Use this 4 times per day.
   • For males with painful pox on the tip of the penis, this also works.
10. What to Expect:
    • Expect new chickenpox every day for 4 or 5 days.
    • Most children get 400 to 500 chickenpox.
11. Return to School:
    • Your child can go back to school after all the sores have crusted over.
    • Most often, this is day 6 or 7 of the rash.

Call Your Doctor If

• Chickenpox look infected (draining pus, scabs become larger)
• Gets any new chickenpox after day 6
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

#AAP