CHICKENPOX

Main Symptoms

• Chickenpox progress within 24 hours through the following stages: 1) small red bumps, 2) thin-walled water blisters on top, 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.

Cause

• Varicella virus.

See More Appropriate Topic (instead of this one) If

• Doesn't look like chickenpox, see RASHES, WIDESPREAD AND CAUSE UNKNOWN.

WHEN TO CALL YOUR DOCTOR FOR CHICKENPOX

Call 911 Now (your child may need an ambulance)

• 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, trouble walking or stiff neck.  
• Breathing is difficult.
• Bleeding into the chickenpox.  
• Fever above 104°F (40°C).
• Age less than 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 9am and 4pm) If

• You think your child needs to be seen.
• Teen 13 years or older has chickenpox.
• Exposed to chickenpox within last 5 days and never received chickenpox vaccine.
• Lymph node has become large and tender.
• Fever lasts for more than 4 days OR returns after going away for more than 24 hours.  
• Scab or sore is draining yellow pus OR becomes much larger in size than the others (size lareger 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

1. Cool Baths:  For itching, give cool baths for 10 minutes as often as needed (caution: avoid any chill).  Can add baking soda 2 oz. per tub. Baths don't spread the chickenpox.
2. 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 Caladryl because the Benadryl in it can be absorbed across the inflamed skin and cause side effects).
3. Benadryl Medicine:  If itching becomes severe or interferes with sleep, give oral Benadryl (see Dosage table).
4. Discourage Scratching:  Trim fingernails and wash hands frequently with an antibacterial soap to prevent impetigo. Discourage picking and scratching.
5. 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 infections).
6. Soft Diet:  Offer a soft diet for painful mouth and throat ulcers.  For infants, give fluids by cup rather than bottle because the nipple can cause increased pain.
7. Antacid for Mouth Pain:  For severe mouth ulcers in children over age 4, use 1 teaspoon 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.
8. 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 or 1% Nupercaine ointment (no prescription needed) 4 times per day.  This also works for males with painful pox on the tip of the penis.
9. Contagiousness:  Your child can return to day care or school after all the sores have crusted over, usually day 6 or 7 of the rash.
10. Expected Course:  Expect new chickenpox every day for 4 or 5 days.  Most children get 400 to 500 chickenpox.
11. Call Your Doctor If:
    • Chickenpox look infected (draining pus, scabs become larger).
    • Gets any new chickenpox after day 6.
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2003

See Other Topics:

• Rashes, Widespread and Cause Unknown

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