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  • Chickenpox

    Definition

    • The chickenpox rash is a rash all over the body. It starts as small red bumps. The bumps change to blisters or pimples. The bumps change to open sores, and finally they scab over.
    • Caused by the chickenpox virus.

    Symptoms

    • Chickenpox starts with some small water blisters or pimples on the head and trunk.
    • Chickenpox progress within 24 hours through the next 5 stages:
      1. small red bumps
      2. thin-walled water blisters
      3. cloudy blisters
      4. open sores, and finally
      5. dry brown crusts
    • Rash is all over the body. Most often, starts on the head and back.
    • Repeated crops of new chickenpox keep appearing for 4 to 5 days. Therefore, all 5 stages are 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.
    • Known contact to a child with chickenpox 10 – 21 days earlier
    • Main complication: Skin infections from scratching.

    Causes

    • Chickenpox is caused by a virus. It is called Varicella. Chickenpox can be prevented by getting this vaccine.

    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.

    When to Call Us for Chickenpox

    Call 911 Now (your child may need an ambulance) If:

    • Not moving or too weak to stand
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Your child looks or acts very sick
    • Bright red skin or red streak
    • Very painful swelling or very swollen face
    • New red rash in addition to chickenpox rash
    • Hard to wake up OR confused
    • Trouble walking or stiff neck
    • Trouble breathing
    • Bleeding into the chickenpox
    • Fever more than 104° F (40° C)
    • Age less than 1 month old
    • Vomits 3 or more times
    • Eye pain or constant blinking
    • Took a steroid medicine within past 2 weeks
    • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant)
    • Chronic skin disease (such as eczema)
    • Chronic lung disease (such as cystic fibrosis)
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Age less than 1 year old
    • Teen 13 years or older has chickenpox
    • Been near to person with chickenpox or shingles in last 5 days. Also, healthy person who never had a chickenpox vaccine.
    • One lymph node gets larger and more tender
    • Fever lasts more than 4 days
    • Fever returns after gone for more than 24 hours
    • Scab or sore drains yellow pus
    • One sore gets much larger in size than the others
    • Gets new chickenpox after day 6

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns

    Parent Care at Home If:

    • Chickenpox with no complications

    Care Advice for Chickenpox

    What You Should Know:

    • Chickenpox is caused by the varicella virus.
    • It’s now uncommon because of the chickenpox vaccine.
    • Your job is to keep your child comfortable and to limit the itching.
    • Here is some care advice that should help.

    Cool Baths:

    • 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.

    Calamine Lotion for Itching:

    • Put calamine lotion on the chickenpox that itch the most.
    • You can also use 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. This can cause side effects in kids.

    Benedryl Medicine for Itching:

    • If itching becomes severe or interferes with sleep, give Benadryl by mouth. See Dose Table.

    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.

    Fever Medicine:

    • Give acetaminophen (such as Tylenol) for fever above 102° F (39° C).
    • Never use aspirin. Reason: Risk of Reye syndrome.
    • Also, don’t use ibuprofen. Reason: May increase risk of bad strep skin infections.

    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.

    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: 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. Can also put it on with a cotton swab.
    • Caution: Do not use regular mouth washes, because they sting.

    For Passing 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.

    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.

    What to Expect:

    • Expect new chickenpox every day for 4 or 5 days.
    • Most children get 400 to 500 chickenpox.
    • They get less pox if they’ve had the vaccine.

    Prevent the Spread of Chickenpox in the Office:

    • If your child needs to be seen, call first to the office.
    • Try to bring another adult. Have one adult enter the office first for instructions.
    • For nonurgent problems, the doctor may do an exam in the car.

    Call Your Doctor If:

    • Chickenpox look infected (draining pus, scabs become larger)
    • Gets any new chickenpox after day 6
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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