Care4Kids

Chickenpox

Not that long ago, chickenpox was one of the more troublesome diseases, for both children and their parents. With the introduction of a vaccination for chickenpox in the middle 1990s, and with the majority of children now getting vaccinated, the number of kids getting covered with pox has greatly decreased.

Chickenpox was formerly a late winter and early springtime disease, but with widespread usage of the vaccination, it is not so seasonal and can occur year-round.

Some kids breeze through it with just a few spots. Others have a terrible time with hundreds of itchy spots and flu-like symptoms. Here’s information to help you cope when your child is confined with the chickenpox.

CAUSE
Chickenpox is a highly contagious childhood disease with one key symptom: lots of little “pox,” a distinctive rash. In the pre-chickenpox vaccine era, it was most common in children between the ages of 5 and 10, and could affect infants and adults.

It can still infect all age groups, but the overall incidence has markedly decreased in all age groups, now peaking in the 10- to 14-year-old age group. It’s so contagious that if one child in your home gets it, there’s a 90 percent chance that others who have never had chickenpox or have been vaccinated, will get it too.

Once infected, a child usually will never get chickenpox again.

For a child who has received one dose of the chickenpox vaccination, there is only a 10 to 20 percent chance that she will get chickenpox at some point, and the case is usually very mild.

When vaccinated with the recommended two doses of vaccine (usually at 12 months and again at kindergarten time), there is very little chance she will get chickenpox.

Chickenpox is spread through direct body contact, through droplets when an infected person sneezes or coughs or from clothing that is freshly soiled by discharge from the rash of an infected person. Children in larger cities or clustered in day-care or school are more likely to catch chickenpox.

An infected child is believed to be contagious for one to two days before the first spots appear and remains contagious until all the spots are crusted over. Once all the spots have formed scabs, the child is no longer infectious and can return to school. This usually takes about seven days.

You may not know when your daughter has been exposed to chickenpox. Some children are exposed to it several times and don’t come down with it.

In general, though, chickenpox will show up about 14 to 16 days after exposure, although the onset may occur as soon as 10 days and as late as 21 days afterwards.

There’s not much you can do about preventing exposure to other children if you didn’t expect your son to come down with chickenpox. But if you know he was exposed, look for spots regularly and keep him away from other kids if possible.

SYMPTOMS
Chickenpox usually starts with a fever or headache. Some children just feel a little restless and won’t eat. Spots take form rapidly as a red rash, continuing to erupt for about three or four days.

The rash usually starts on the abdomen, chest and back, and spreads to the face and scalp. There are often more spots on covered areas, such as armpits and the groin area.

They aren’t as numerous on the child’s arms and legs, but they can develop inside the ears, on the eyelid, inside the mouth, within the vagina, everywhere.

Within a few hours, each spot forms a little cyst on top, sometimes in the shape of a teardrop. It may appear full of clear, pale yellow fluid. After a day or so, the fluid turns cloudy, then crusts over.

These cysts are easily broken and form a scab. Some spots progress faster than others, so your son may exhibit several different stages of the disease at once. As always, when in doubt, check with his doctor.

In a child who has previously been vaccinated, the rash will often begin on the trunk or trunk and face, but the lesions are typically less common, and usually don’t last as long.

TREATMENT
Consider calling your child’s physician in the event of significant fever, around 103ºF or higher, especially if it is associated with extreme discomfort or poor oral intake. Encourage fluids.

Discomfort can be managed at home using ibuprofen. Have your daughter’s physician or pharmacist confirm the dosage, and use it sparingly.

IMPORTANT: NEVER GIVE YOUR CHILD ASPIRIN FOR PAIN OR FEVER. Aspirin use during chickenpox infection has been linked to Reye’s syndrome, a life-threatening condition.

Not all kids will have a fever, but all will have spots, and most will want to scratch them. This can cause secondary infections and lifelong scarring, so take these steps to make your child more comfortable:

PREVENTION
A vaccine can prevent chickenpox and reduce the risk of shingles, a related viral infection. Ask your pediatrician about any possible side effects associated with the vaccine.

According to the Centers for Disease Control (CDC), children who have a severe allergy to gelatin or the antibiotic neomycin should not get the chickenpox vaccine.

All children should receive two doses of the vaccine. The first dose is administered between the ages of 12 and 15 months and a booster shot should be given between 4 to 6 years of age.

Adults who have never had chickenpox may have developed a natural immunity to it, so their doctor may want to get a blood test to check for this before being vaccinated.

Until all children are protected by immunization, chickenpox will continue to infect children. Make sure your kids are protected. Meanwhile, keep your child out of school or day-care until all the spots have formed scabs.

If given within three days of exposure, for children who are 12 months and older, and adults, the vaccine may prevent or at least lessen the severity of the disease in many cases.

WHEN TO CALL THE DOCTOR
Never take chickenpox lightly. There are a number of possible complications, including serious illnesses such as pneumonia and encephalitis. Call your child’s doctor if you notice any of the following:

DISEASETRANSMISSIONINCUBATION PERIODCONTAGIOUS PERIOD
Bronchiolitis Spread via respiratory droplets through sneezing or coughing  2 to 10 days  Onset of cough until 7 to 10 days 
Chickenpox (Varicella) Airborne or via skin contact with lesions  10 to 21 days  2 days before rash appears until all sores have crusted 
Colds Spread via respiratory droplets or direct contact with infected person or object  2 to 4 days  Onset of runny nose until fever is gone

 
Croup (viral) Spread via respiratory droplets or contact with infected person or object  2 to 6 days  Onset of cough until fever is gone
 
Diarrhea Contact with feces  Depends on causative agent (bacterial 1 to 7 days; viral 1 to 4 days)  Depends on causative agent; usually until stools are formed. (See specific agents)
 
Fifth Disease (Parvo virus) Spread via respiratory droplets  Usually 4 to 14 days, but can be as long as 21 days  7 days before rash until rash begins 
Hand-foot-mouth (Coxsackie) Spread via respiratory droplets, fecal/oral contact or fluid from blisters  3 to 6 days  Onset of mouth ulcers until fever is gone (respiratory tract shedding usually 1 week; fecal can be several weeks)
 
Hepatitis A Fecal contact  15 to 50 days  1 to 2 weeks before jaundice begins until 1 week after onset of jaundice
 
Hepatitis B Contact with infected blood/body fluids  45 to 160 days  Indefinite period. If Hepatitis e antigen is positive, at risk for transmission 
Herpes Simplex Oral/genital skin contact  2 days to 2 weeks  Initial infection: 1 week to several weeks (oral/genital). Recurrent infection: 3 to 4 days
 
Impetigo Direct skin contact with lesion and contact with infected objects  7 to 10 days  Onset of sores until 1 day on antibiotics
 
Influenza Spread via respiratory droplets or contact with infected person or object  1 to 4 days  24 hours before onset of symptoms until fever is gone, about 7 days
 
Lice Spread via contact with skin or hair  10 to 14 days  Onset of itch until 24 hours after first treatment
 
Meningococcus Spread via respiratory droplets  1 to 10 days  7 days before symptoms to 24 hours after treatment begins
 
Mononucleosis Contact with infected saliva  30 to 50 days  Undetermined, but usually 6 weeks
 
MRSA Spread via contact with infected person, person who is a carrier of the disease, or contaminated surface.  One to 10 days  Varies depending on whether infection is active and if person is seeking treatment 
Pertussis (whooping cough) Spread via respiratory droplets  Five to 21 days  Two weeks after onset of cough or until five days on antibiotics
 
Pink-eye or Conjunctivitis (bacterial) Spread via contact with eye drainage
 
2 to 7 days  Onset of pus until symptoms have resolved
 
Rotavirus Direct or indirect contact with infected people  2 to 4 days  Before onset of diarrhea until 10 to 12 days after onset
 
Salmonella, Shigella, Campylobacter Fecal contact  Salmonella - 12 to 36 hours
Shigella & Campylobacter - 1 to 7 days 
Contagious until diarrhea is resolved; sometimes with prolonged excretions with salmonella
 
Scabies Contact with clothing, bedding or skin of infected animal or person  4 to 6 weeks (previous exposure 1 to 4 days)  Onset of itch until one treatment completed
 
Scarlet fever Spread via airborne respiratory droplets and direct contact  1 to 2 days  Onset of fever or rash until 1 day on antibiotics
 
Sore throat (viral) Spread via respiratory droplets  2 to 5 days  Onset of sore throat until fever is gone 
Strep throat Spread via respiratory droplets  2 to 5 days  Onset of sore throat until 1 day on antibiotics 

2006 Red Book, Report of the Committee on Infectious Disease, American Academy of Pediatrics

Airborne - droplets nuclei that remain suspended in the air for long periods
Respiratory droplets - droplets propelled for a short distance, such as talking, sneezing, coughing, etc.


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