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Chickenpox in children – infection, patterns, incubation period

Picture of topless child with red dots on torso chickenpox

This post is also available in: Svenska

Chickenpox is a highly contagious viral disease. Its symptoms are fever and fluid-filled blisters that affects virtually all unvaccinated children in Sweden. The blisters itch and can be found all over the body. The incubation period for chickenpox is 2-3 weeks and it can be spread before the disease has broken out. Chickenpox is often mild, but sometimes there are complications.

How do I recognize chickenpox?

Chickenpox symptoms are quite obvious, so you can often tell when your child has been exposed to the infection. After 2-3 healthy weeks (during the incubation period) your child will get a fever, cough and will begin to complain or have a sore body. After one or two days, the rash appears. The first red dots will develop into fluid-filled blisters within a day. They sit one by one on a red base. The number of blisters differ between children. Some get it all over their body while others get only a few. Some people get so few that it doesn’t even show.

Tired child with red dots all over face - chickepox
Chickenpox are small fluid-filled blisters on a red base that itch.

Explore our visual guide to children’s rashes and spots

Read more about hand, food and mouth disease

Chickenpox itches

The more your child scratches, the more itchy the chickenpox gets. Additionally, chickenpox can turn into bacterial infections (similar to impetigo) are likely to occur and, when you scratch, you also increase the risk of scars forming.

We often prescribe antihistamine medications to children who have a lot of problems with their chickenpox. From experience, it does not help very much at all, unfortunately.

A colleague tested the market’s entire range of medicines and non-medicines to try to ease the itchiness of chickenpox on their own children. She announced that the only thing that worked was a zinc spray. I haven’t seen any scientific studies on this, so take it for what it is.

She also suggested dressing your child in a soft onesie around the clock. Partly to hide the blisters (when it’s not visible, you scratch less), and partly to not have to pull fabric over them more often than necessary (as this irritates their blisters).

Chickenpox on mucous membranes

Unfortunately, chickenpox does not only appear on the skin, but can also settle on the mucous membranes. If they sit on the mucous membranes of the mouth, it becomes difficult to drink and eat. If they sit on the mucous membranes of the urinary tract, peeing can hurt terribly. One of the more common reasons why children with chickenpox need hospital treatment, is that they are unable to drink enough.

If your child has a lot of blisters in their mouth, see if you can give them icecream. Otherwise, try giving acetaminophen. However avoid ibuprofen in chickenpox, as there are suspicions that it may increase the risk of bacterial infections in the blisters. Try everything you can think of to get fluid into your child. But if you do not succeed, seek the children’s emergency room. Visit with another adult so that one adult can stay outside with the child while the other can enter the hospital and sign up. You will be shown to a room where you are not at risk of infecting other children.

Chickenpox virus is one of the most contagious viruses. The air in a room where a chickenpox disease has been, is considered contagious for a few hours afterwards.

Read more about mouth blisters in children

Chickenpox is dangerous in children with poor immune systems

The chickenpox virus is quite aggressive. A healthy well-fed child with a good immune system usually manages to keep the virus out of the brain and lungs. But a child with a compromised immune system (congenital or as a result of drug treatment) does not always manage to fight it off.

Children with compromised immune systems who have not had chickenpox, should therefore be treated with antiviral medications, sometimes even when they have been exposed to infection!

If your child has a congenital immunodeficiency or is being treated with medicines that impair the immune system (for example high-dose cortisone, chemotherapy or many of the anti-inflammatory medications against childhood rheumatism, inflammatory bowel disease or after transplantation), make sure you know what to do if the child is exposed to chickenpox infection.

Guidelines for doctors regarding chickenpox in children with childhood rheumatism can be found here.

Vaccination is not recommended in children with compromised immune systems as the vaccine is a live attenuated vaccine. But if the immune system is impaired as a result of medication, it may be a good idea to vaccinate before giving the medication. If this is not possible, siblings can be vaccinated to protect the immunocompromised child in the family.

Chickenpox in newborns

If the baby’s mother has had chickenpox, or is vaccinated, she will give antibodies to the baby at the end of pregnancy. These protect the baby’s first few months of life. This is great! Because chickenpox in newborns who haven’t been protected by their mother, can become really serious.

If you, as the pregnant woman, have not had chickenpox, and your child is exposed to the infection in the first few months of their life, you should seek medical care. Preferably speak to a pediatrician or infectious disease doctor. Or a general practitioner who is likely to talk to the above.

Guidelines for the care of newborns where moms has not had chickenpox can be found here.

There are also guidelines on chickenpox during pregnancy and chickenpox disease in newborns.

Do I dare go home after giving birth when our older sibling has chickenpox?

This is a common question. Do I dare go home with my newborn baby when our older sibling has chickenpox? Is the baby going to get any medication? If mom has had chickenpox or is vaccinated, the answer is – yes, go home, the baby doesn’t need medication. The baby is protected by the mom’s antibodies. If the baby gets infected by the sibling, they are usually fine. But seek a pediatrician or infection specialist if a newborn baby (up to three months of age) gets chickenpox.

Does hand washing help against the infection?

No, the infection is airborne. It can remain in the air for two hours after the infected person has left. Therefore, it makes no sense to try to prevent the infection within the family.

It is more important to prevent spreading the infection to other people, as you don’t know if they have a compromised immune system. Children with chickenpox should not be brought into supermarkets; should not travel by bus or metro; and certainly should not go to the library; or to planned doctor’s appointments. When we receive children with chickenpox in the children’s emergency room, we do so in special isolation rooms. So please tell staff members that you suspect that your child has chickenpox while you’re outside the hospital, via intercom or similar.

How long is chickenpox contagious?

It is contagious until the last blister has dried up, often 7-14 days after the disease has broken out. Preschools usually have rules that children should not attend until the blisters are dried up. But it is really pointless. Since the disease is contagious two days before the blisters break out, the infection is already present in the preschool group. But don’t try to send your child to preschool with undried chickenpox. You’ll just cause trouble.

What about chickenpox and shingles?

The two diseases of the same virus. The first time a person contracts the virus, they will have chickenpox with blisters all over their body. After that, some of the virus survive in the nerve cells inside the body and kept in check by the immune system, hopefully for life. But if the immune system is weakened by medication, disease or age, the chickenpox virus cannot always be kept in line. That’s when shingles comes along. But usually only from particular nerve cells. So the blisters then spread over a smaller part of the body.

A person with shingles can infect a person who has not had chickenpox, with chickenpox. But a person with chickenpox, who exposes a person who has had it, will only trigger that person’s immune system. Being exposed again, reduces the risk of shingles, rather than increases it. Theoretically, therefore, grandparents visiting children with chickenpox would reduce the risk of shingles for them.

When should I visit the children’s emergency room?

  1. If your child has a compromised immune system due to medication or a disease, and the child’s doctor has given you instructions to visit the children’s emergency room in case of chickenpox.
  2. If you cannot get your child to drink.
  3. If your child has difficulty breathing when they have chickenpox. This could be chickenpox pneumonia that needs hospital treatment.
  4. If your child becomes withdrawn or has seizures. This could be chickenpox encephalitis that needs hospital treatment.

Read more about meningitis in children

Read more about oral rehydration solution (ORS) for children

Read more about breathing difficulties in children

Read more about pneumonia in children

Remember: do not go into the children’s emergency room with your chickenpox-infected child until you have received the go-ahead from the staff. Expect children with compromised immune systems in the waiting room that will become terminally ill if exposed to chickenpox.

When should I attend a medical center?

If the child gets permanent, pus-filled blisters with yellowish-brown crusts. This could be a bacterial infection that needs antibiotics.

Read more about impetigo in children

Call the medical center first! They have to arrange for your visit so that others will not be infected.

Infecting children with chickenpox on purpose is a bad idea

A reader asked me what I think about subjecting their children to chickenpox contamination on purpose by arranging a chickenpox party. I don’t like it! A parent’s job is to take care of their child and do what is in your power for the child to feel as good as possible. Exposing your child to the infection of a virus that basically always causes discomfort, and in rare cases causes serious illness, is not, for me, a well thought-out part of loving parenting.

If you want to control when your child is exposed to chickenpox, it is a much better idea to consider vaccination. Not because that is when the child will get chickenpox, but then at least you avoid the surprise effect.

Read more:

Pneumonia in children – symptoms and treatment

Meningitis in children – fever, neck stiffness, sore neck

Streptococcus in children – tonsillitis, perianal strep, scarlet fever

Impetigo in children – infection and treatment

Hand, foot and mouth disease – blisters in children

Rashes and red spots in children – a visual guide

Blisters in the mouth in children

Pros and cons of the chickenpox vaccine

Chickenpox in children – infection, patterns, incubation period

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