Chickenpox

Is this your child's symptom?

• A rash all over the body caused by the chickenpox virus.
• The chickenpox rash starts as small red bumps. The bumps change to blisters or pimples. The bumps change to open sores, and finally they scab over.
• A doctor has told you that your child has chickenpox.
• Or your child had close contact with another person who has it (or shingles). The contact should be 10-21 days earlier.

Symptoms of Chickenpox

• 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 or shingles 10 - 21 days earlier
• Main related problems: skin infections from scratching.

Cause of Chickenpox

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

When to Call for Chickenpox

Call 911 Now

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

Call Doctor or Seek Care Now

• Bright red skin or red streak
• Very painful swelling or very swollen face
• New red rash in addition to chickenpox rash
• Walking is not steady
• Trouble Breathing
• Bleeding into the chickenpox
• Fever higher 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. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Chronic skin disease (such as eczema)
• Chronic lung disease (such as cystic fibrosis)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• 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 being gone 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
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Chickenpox with no other problems

Care Advice for Chickenpox

What You Should Know About Chickenpox:

• 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:

• 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.

Allergy Medicine for Itching:

• If itching becomes severe, give a dose of Benadryl.
• No prescription is needed. Age limit: 1 and older.

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 higher than 102° F (39° C).
• Never use aspirin. Reason: risk of Reye syndrome.
• Also, don't use ibuprofen products (such as Advil). 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 (Age 1 Year and Older):

• 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 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
• Age over 6 years. 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.
• Caution: do not use regular mouth washes, because they sting.

Ointment For Pain With Passing Urine:

• For girls with painful genital ulcers, use petroleum jelly (such as Vaseline).
• Put on the sores as needed.
• 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
• You think your child needs to be seen
• Your child becomes worse

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 01/16/2025

Last Revised: 01/13/2025

Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.