Should Your Child See a Doctor?
- Distinctive, widespread rash made up of small red bumps that change to blisters or pimples, then open sores and then crust over
- MINIMAL required findings: some small water blisters or pustules on the head and trunk
- Chickenpox progress within 24 hours through the following 5 stages: 1) small red bumps, 2) thin-walled water blisters, 3) cloudy blisters, 4) open sores, and 5) dry brown crusts
- Rash is on all body surfaces, but usually 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) occur normally in the mouth, eyelids, and genital area.
- Fever is usually present (the more the rash, the higher the fever)
- Known exposure to chickenpox 10 - 21 days earlier
- Main complications: secondary infections from bacteria
- Varicella (chickenpox) virus. Chickenpox can be prevented by the varicella vaccine.
Return to School
- Your child can return to child care or school after all the sores have crusted over, usually day 6 or 7 of the rash.
When to Call Your Doctor for Chickenpox
Call 911 If…
- Your child is not moving or too weak to stand
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Area of red, tender skin or red streak
- Very painful swelling or very swollen face
- Speckled red rash
- Difficult to awaken, confused (delirious), trouble walking or stiff neck
- Breathing is difficult
- Bleeding into the chickenpox
- Fever over 104° F (40° C) and not improved 2 hours after fever medicine
- Age under 1 month old
- Vomiting 3 or more times
- Eye pain or constant blinking
- Chronic disease that causes decreased immunity (e.g., cancer)
- Taking oral or inhaled steroids (e.g., asthma) within past 2 weeks
- Chronic skin condition (e.g., eczema)
- Chronic lung disease (e.g., cystic fibrosis)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think your child needs to be seen
- Teen 13 years or older has chickenpox
- Exposed to chickenpox or shingles within last 5 days and never received chickenpox vaccine
- Lymph node has become large and tender
- Fever present over 4 days
- Fever returns after gone over 24 hours
- Scab or sore is draining yellow pus OR becomes much larger in size than the others (size larger than a dime or 10 mm)
- Gets new chickenpox after day 6
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
Parent Care at Home If
- Chickenpox with no complications and you don't think your child needs to be seen
Home Care Advice for Chickenpox
- Cool Baths: For itching, give cool or lukewarm baths for 10 minutes as often as needed (caution: avoid any chill). Can add 2 ounces (60 ml) baking soda. per tub. Baths don't spread the chickenpox.
- Calamine Lotion: Apply calamine lotion to the chickenpox that itch the most or massage them with an ice cube for 10 minutes (Don't use any lotion containing Benadryl because it can be absorbed across the inflamed skin and cause side effects).
- Benadryl Medicine: If itching becomes severe or interferes with sleep, give oral Benadryl (see Dosage table).
- Discourage Scratching: Trim fingernails and wash hands frequently with an antibacterial soap to prevent impetigo (infected sores). Discourage picking and scratching.
- Fever Medicine:
- Give acetaminophen (e.g., Tylenol) for fever above 102° F (39° C)
- Never use aspirin (Reason: risk of Reyes syndrome)
- Also don't use ibuprofen (Reason: may increase risk of severe strep skin infections)
- Soft Diet: Offer a soft diet for painful mouth and throat ulcers. For infants, give fluids by cup, spoon, or syringe rather than bottle because the nipple can cause increased pain.
- Liquid Antacid for Mouth Pain: For severe mouth ulcers in children over age 4, use 1 teaspoon (5 ml) of a liquid antacid as a mouth wash 4 times per day after meals. For younger children, put a few drops in the front of the mouth after meals.
- Painful Urination:
- For females with painful vulva ulcers, apply petroleum jelly to the area as needed.
- For severe pain, use a numbing ointment such as 2.5% xylocaine ointment (no prescription needed) 4 times per day.
- For males with painful pox on the tip of the penis, this also works.
- Contagiousness: Your child can return to child care or school after all the sores have crusted over, usually day 6 or 7 of the rash.
- Expected Course: Expect new chickenpox every day for 4 or 5 days. Most children get 400 to 500 chickenpox.
- Preventing Exposure of Office to Chicken Pox: If need to be seen, consider bringing 2 adults and having one enter office first for instructions. For nonemergent problems, doctor may examine child 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
And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.
- American Academy of Pediatrics Committee on Infectious Diseases. Severe invasive Group A streptococcal infections: A subject review. Pediatrics. 1998;101:136-139.
- American Academy of Pediatrics: Committee on Infectious Diseases. Wound Infections. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
- American Academy of Pediatrics: Committee on Infectious Diseases. Chickenpox. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
- English R. Varicella. Pediatr Rev. 2003;24 (11):372-379.
- Fisher RG and Edwards KM. Varicella-zoster Pediatr Rev. 1998;19 (2):62-70.
- Fleisher G, et al. Life-threatening complications of varicella. Am J Dis Child. 1982; 135:896-899.
- Gershon A. Varicella-zoster virus infections. Pediatr Rev. 2008;29 (1):5-11.
- Lesko SM, O'Brien KL, Schwartz B, Vezina R, Mitchell AA. Invasive Group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella. Pediatrics. 2001;107:1108-1115.
- Watson B, Seward J, Yang A, Witte P, Lutz J, Chan C, et al. Postexposure effectiveness of varicella vaccine. Pediatrics. 2000;105:84-88.
- Zerr DM, Alexander ER, Duchin JS, Koutsky LA, Rubens CE. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics. 1999;103 (4):783-790.
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.
Last Reviewed: 8/1/2010
Last Revised: 10/1/2010
Copyright 1994-2011 Barton D. Schmitt, M.D.