Chickenpox in children: symptoms, home care and when to get help

NHS inform describes chickenpox, known medically as varicella, as a mild and common illness caused by the varicella-zoster virus that mostly affects children but can be caught at any age. It says the virus spreads quickly and easily, is most common in children under 10, and that children usually catch it in winter and spring, particularly between March and May.

The NHS gives a similar summary: a common infection that spreads easily, usually better after 1 to 2 weeks, but serious in some people.

The main symptom is an itchy, spotty rash that can appear anywhere on the body. Before or after it appears a child may have a high temperature, aches and pains, generally feel unwell and lose their appetite. NHS inform says these flu-like symptoms, especially fever, tend to be more common and worse in adults than in children.

The NHS describes three stages, although new spots can appear while others are becoming blisters or forming scabs:

• Stage 1, small spots: anywhere on the body, including inside the mouth and around the genitals, where they can be painful; colour varies with skin tone and can be harder to see on brown and black skin.

• Stage 2, blisters: the spots fill with fluid and become very itchy blisters that may burst.

• Stage 3, scabs: the blisters form scabs, some flaky and some leaking fluid.

NHS inform says the spots often appear in clusters, behind the ears, on the face and scalp, chest and belly and arms and legs, but can also be inside the ears and mouth, on the palms and soles, and in the nappy area. Blisters become very itchy after about 12 to 14 hours, after a day or two the fluid turns cloudy and they start to dry and crust, and after 1 to 2 weeks the crusts fall off naturally. New spots can keep appearing in waves for 3 to 5 days after the rash begins.

The NHS says the spots start appearing around 1 to 3 weeks after someone has caught chickenpox.

The NHS says most children can be treated at home. Its advice is:

• drink plenty of fluids (ice lollies are suggested if a child is not drinking)

• give paracetamol for pain and discomfort

• cut fingernails and put socks on hands at night to stop scratching

• use cooling creams or gels from a pharmacy, and ask a pharmacist about antihistamine medicine for itching

• bathe in cool water, pat the skin dry rather than rubbing, and dress in loose clothes

• do not use ibuprofen unless a doctor tells you to, because it may cause serious skin infections

• do not give aspirin to children under 16, and discourage scratching, which can scar

The NHS says you can spread chickenpox from 2 days before the spots appear until they have all formed scabs, usually 5 days after the spots appeared. It can be caught by being in the same room as someone with it, by touching things with fluid from the blisters on them, and from someone with shingles if you have not had chickenpox before; you cannot catch shingles from someone who has chickenpox.

NHS inform advises keeping children off school or nursery until all spots have crusted over, and keeping away from public areas where possible. Both sources stress staying away from newborn babies, pregnant women and anyone with a weakened immune system, because chickenpox can be dangerous for them.

The NHS says to see a GP if you are not sure it is chickenpox or if you are breastfeeding and have symptoms, and to contact the surgery before you go in, telling the receptionist you think it might be chickenpox. It says to get help from NHS 111 now if symptoms get worse, such as red, hot or painful skin around the blisters, if a child shows signs of dehydration such as fewer wet nappies, if you have a weakened immune system or are pregnant and have been near someone with chickenpox, if a newborn may have it or has been near it, if there is more breathlessness than usual, or for any other symptom that worries you. Call 111 for advice for a child under 5.

NHS inform adds chest pain, difficulty breathing, drowsiness, cold hands and feet and infected blisters to its list of reasons to contact the GP practice urgently. The NHS says some people may be able to take medicine to prevent complications, which needs to be started within 24 hours of the spots appearing, so ask early.

The NHS says children are now offered the MMRV vaccine, which protects against measles, mumps, rubella and chickenpox, with 2 doses at 12 months and 18 months, and older children born on or after 1 January 2020 are also offered 1 or 2 doses. People who live with someone with a weakened immune system, for example someone having chemotherapy, may be offered the chickenpox vaccine on the NHS. NHS inform confirms that the vaccine is the way to prevent chickenpox.