Chickenpox is a viral infection that causes fever, an itchy rash with spots, and sometimes blisters all over the body. It used to be a common childhood illness in the United States, but it is much less common since the varicella vaccine became available in the mid-1990s.
What causes chickenpox?
A virus called varicella zoster (VZV) causes chickenpox. The VZV virus can be spread through saliva, coughing, sneezing, and contact with fluid from the blisters.
What are the symptoms of chickenpox?
Most people don’t know their children have chickenpox until they see the itchy, red spots, usually starting on the back, belly, and face. People will be infected with the virus seven to 21 days before the rash and other symptoms develop. Your child can accidentally spread the chickenpox virus to others about 48 hours before the skin rash appears. Some of the earlier symptoms of varicella or chickenpox infection your child might have are:
- Fever (usually in the 101-102°F range)
- Loss of appetite
- Sore throat
The rash appears in waves of bumps, blisters, and scabs throughout the infection. The rash may be very itchy until it scabs over with a crust. It may spread over more of your child’s body or be more severe if your child has a weak immune system or a skin disorder like eczema. Your child is still contagious until all the blisters have scabbed over. The chickenpox rash usually takes seven to 14 days to disappear completely.
What should I do if I think my child has chickenpox?
You should always call your pediatric care provider any time your child has an unexplained rash, especially if they also have cold symptoms or fever. Also, tell your OBGYN or midwife right away if you are pregnant and your child has chickenpox.
Most children with chickenpox will not need any additional treatment or medication to get better. However, your child must stay home from school and daycare to avoid spreading the virus. Children typically are able to return to normal activities within one to two weeks of diagnosis. Once chickenpox heals, most people become immune to the virus. VZV typically stays dormant (asleep) in a healthy person’s body.
Most chickenpox infections don’t need special medical treatment. But sometimes, problems can happen. Call your provider if your child:
- has a fever that lasts for more than 4 days
- has a severe cough or trouble breathing
- has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
- has a severe headache
- is very drowsy or has trouble waking up
- has trouble looking at bright lights
- has trouble walking
- seems confused
- is vomiting
- seems very ill
- has a stiff neck
How can I help my child feel better if they have chickenpox?
If your child has a headache, aches, pains, or fever when they have chickenpox, your pediatric provider may recommend giving them some acetaminophen (Tylenol) or less commonly, Ibuprofen (Advil). Never give aspirin to kids with chickenpox. It can lead to a serious illness called Reye’s syndrome.
Your doctor may prescribe antihistamine medications or topical ointments to help stop the rash from itching. There are also over-the-counter ointments and creams for itch relief. Other chickenpox rash treatment tricks are to:
- Give your child lukewarm oatmeal or baking soda baths
- Apply unscented lotion, chilled in the refrigerator, or calamine lotion (not on the face near the eyes) to itchy areas
- Dress your child in lightweight, soft clothing to avoid triggering itching
- Trim and clean your child’s fingernails to prevent scabs or skin infections that can lead to skin scarring
- Have them wear mittens or socks on their hands at bedtime so that they don’t scratch their rash while asleep (permanent scarring is possible)
Depending on your child’s age and health, the extent of their infection, and where they are in the course of the virus, your pediatric provider may prescribe antiviral medicine for your child. If members of your household have been exposed and are not vaccinated, urgent vaccination may also be an option to discuss with your provider.
What are the risks of being infected?
Complications from chickenpox most often affect infants, older adults, people with weak immune systems, and pregnant women. According to the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), possible but rare complications from severe infections can include:
- Lung infection (pneumonia)
- Encephalitis (brain infection)
- Bleeding problems or bloodstream infections (sepsis)
- “Flesh-eating” bacterial infection
If a pregnant person is not immune to chickenpox (either because they have not been infected or they never received the vaccine) and gets infected, their unborn children may be at risk for:
- poor growth
- small head size
- eye problems
- intellectual disabilities
Is the chickenpox vaccine really necessary?
Yes. While most children in the U.S. survive chickenpox, about 1,400 people are hospitalized each year, and around 30 die of the illness. The chickenpox vaccine is highly effective at preventing the virus — if your child gets both recommended doses. They should get their first shot between 12 and 15 months of age and a second booster between 4 and 6 years of age. People 6 years of age and older who have never had chickenpox and aren’t vaccinated can and should get two “catch-up” doses of the vaccine.
Healthcare providers don’t recommend intentionally exposing your child to another child with chickenpox to avoid vaccination. First, there is no guarantee they will get the illness and develop immunity. Second, you won’t know whether your child will have a mild or severe case. No one can predict which child will have a life-threatening reaction to the disease. Vaccine immunity is protective and does not carry these risks.
If your vaccinated child still gets chickenpox, their illness will be much milder. Vaccination reduces how many school days your child misses and cuts down on your days out of work. Additionally, kids vaccinated against chickenpox are much less likely to develop shingles when they get older.
Is there a connection between chickenpox and shingles?
Yes. Remember how if you have had chickenpox, the virus that causes it (VZV) stays in your body without causing any symptoms? Shingles, an extremely painful series of blisters, is also triggered by VZV. The virus is sometimes reactivated in adulthood or when someone’s immune system is weakened.
Fortunately, thanks to the chickenpox (varicella) vaccine, it is less likely that you will encounter chickenpox as a parent to a young child. Talk to your provider about any confusing childhood rashes and to make sense of routine childhood vaccines like varicella.
“Chickenpox.” Kids Health. Nemours. February 2020. https://kidshealth.org/en/parents/chicken-pox.html
“Chickenpox Vaccine: Frequently Asked Questions.” healthchildren.org. American Academy of Pediatrics. October 23, 2013. https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Chickenpox-Vaccine-Frequently-Asked-Questions.aspx
“Chickenpox.” Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282
“About Chickenpox.” CDC. CDC. April 28, 2021. https://www.cdc.gov/chickenpox/index.html