Chickenpox in children: the rash stages, itch relief and who needs urgent advice

Chickenpox is caused by the varicella-zoster virus and spreads quickly and easily from an infected person. NHS inform says it is most common in children under 10 and that children usually catch it in winter and spring, particularly between March and May. The NHS describes it as a common infection that mostly affects children.

After the illness the virus does not leave the body. NHS inform explains that it stays inactive in nerve tissue and can return later in life as shingles. It is possible to catch chickenpox from someone with shingles if you have not had it, but not the other way round.

The main symptom is an itchy, spotty rash that can appear anywhere on the body. Before or after the rash a child may have a high temperature, aches and pains, and loss of appetite. The NHS describes three stages, though new spots can appear while others are already blistering or scabbing.

The NHS says spots start appearing around 1 to 3 weeks after catching the virus. NHS inform adds that the rash starts as small itchy red spots, which develop a blister and become very itchy after about 12 to 14 hours, cloud over and crust after a day or two, and fall off naturally after 1 to 2 weeks. New spots keep appearing in waves for 3 to 5 days, which is why one child can have spots at several stages at once.

Mild flu-like symptoms such as feeling sick, fever of 38C or above, aching muscles and headache can come first. NHS inform notes that these, especially fever, tend to be commoner and worse in adults than in children.

Most families manage chickenpox with simple measures. The NHS lists the following.

• Drink plenty of fluids, with ice lollies as an option if a child will not drink.

• Use paracetamol for pain and discomfort.

• Cut fingernails short and put socks on hands at night to limit scratching, which can cause scarring.

• 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.

The NHS says to get help from NHS 111 now if the symptoms get worse, such as red, hot or painful skin around the blisters; if a child with chickenpox shows signs of dehydration such as fewer wet nappies; if someone with a weakened immune system or who is pregnant has been near chickenpox; if a newborn may have chickenpox or has been near it; or if anyone with chickenpox is more short of breath than usual. NHS inform adds chest pain, blisters that become infected, drowsiness and cold hands and feet to its list of reasons to contact the GP practice urgently, and says to tell the receptionist before attending.

The NHS also notes that some people may be able to take medicine to prevent complications, and that it needs to be started within 24 hours of the spots appearing. This is a decision for a clinician, not something to arrange yourself.

NHS inform names pregnant women, newborn babies and people with a weakened immune system as groups at special risk, who should speak to their GP as soon as they are exposed or develop symptoms; a blood test may check whether they are immune. It says chickenpox occurs in approximately 3 in every 1,000 pregnancies, and that infection in the first 28 weeks carries a small but significant risk of foetal varicella syndrome. A newborn can develop a more serious form if the mother is infected 7 days before or after birth.

This is why the NHS tells families with chickenpox not to go near newborn babies, pregnant women or anyone with a weakened immune system.

UKHSA says infected people should stay away from the setting until 5 days after the rash first appears. The NHS wording is that a child needs to stay off school or nursery until all spots have formed a scab, which is usually 5 days after the spots first appeared. NHS inform says to keep children off until the spots have crusted over, usually 5 to 6 days after the rash starts, and to avoid public areas so as not to expose people at risk.

The NHS says the MMRV vaccine protects against measles, mumps, rubella and chickenpox, with doses at 12 and 18 months, and that children born on or after 1 January 2020 who are older may be offered one or two doses. NHS inform says there is no treatment for chickenpox itself but remedies such as calamine lotion can ease symptoms.