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Baby and childhood infectious diseases: chicken pox BABY AND CHILDHOOD INFECTIOUS DISEASES: CHICKEN POX
Chicken pox, or varicella (for those who like tortuous unpronounceable names), is an acute, highly contagious disease caused by a virus which also produces shingles. It is readily spread by infected droplets from person to person, usually from one who has an upper respiratory tract infection. The incubation period (the time from infection until first symptoms appear) is between 14 and 21 days, usually 15 on average. There is usually no prodromal period; symptoms simply set in rapidly. A person is infectious and may readily spread the virus to others. This capacity starts from 24 hours before the onset of the rash, and for six days after. Once a child has sustained one attack of chicken pox, immunity to further ones appears to be lifelong. But an unfortunate aftermath, often in later life, is that shingles (herpes zoster) may occur. The virus may lie dormant in the nerves for many years, and suddenly become reactivated for reasons unknown, causing extremely painful blistery sores, often on the trunk or face.
The rash is typical. It usually commences on the face, and mucous linings, including the lips, oral cavity and even the tongue, and this can be very uncomfortable and make eating and drinking difficult. The rash then spreads to the body, and the blisters may be extremely numerous over the chest, back and shoulders. They are less common on the arms and legs, and fairly rare on the hands and soles of the feet.
The lesions tend to come in waves, two to four crops, usually in two to six days. They commence as small red blotches. These become raised, and the typical blisters form. They look much like droplets of water with a thin skin over them. These are easy to break. Gradually, the blisters dry out, and scabs form; and these finally fall off, usually by the ninth to thirteenth day. Scabs are said to be highly contagious; and for this reason, pupils are often not readmitted to school until the last scab has vanished.
As the illness progresses, the skin may become itchy. This is usually mild at first, but intensifies as the days pass, and the blisters worsen. As the blister stage advances, a fever often develops.
The blisters often become infected, but apart from this complications are rare, and the disease usually clears up rapidly and leaves little aftermath. Sometimes depressions are left and if on the face they may be lifelong, much to one's annoyance in later life! On rare occasions a viral encephalitis may take place. In some children who may be on special medication, such as steroids for asthma, and in whom, the body's normal immune response to infections is reduced, the disease may run a severe course and present a high risk.
Treatment
Treatment is usually simple. Many cases are very mild, some children having only a dozen blisters or fewer. But others are covered with hundreds of them. Most cases may be treated at home with simple measures.
Bed rest for a few days is suggested, especially if there is a fever and the child is obviously off-colour. Most children are sensible and know when it is time to hit the cot. They are excellent barometers of their own illnesses, as most parents know.
Plenty of fluids are advisable. This replaces fluids lost from sweating when feverish. It also helps to rid the system of dead germs and debris that inevitably collect in the system during any acute infective illness. Water, fruit juice, lemonade and similar drinks are suitable. Adding glucose D to fluid equals food; and if the appetite is reduced, this is a good idea.
There are no food restrictions. But in the acute stages, lack of appetite is common. Also, if the mouth, tongue and lips are severely blistered, eating may be difficult. In fact, the oral cavity often looks a mess, and soggy, yellowish sores look extremely uncomfortable. Jellies, junkets, custards, ice-cream, mashed vegetables, soft stewed fruit, clear broth (but nothing too hot, for it may burn) are best. Eggs, done in a variety of ways, are high in protein, easy to eat and digest and highly palatable.
A daily bath is advisable. Luke-warm water is best. Some advocate adding condy's crystal to the water to make it a very faint pink. This may help check infections if they are present in the blisters. But a note of caution: Condy's is notorious for staining white baths a dirty brown; so very faint pink is adequate—and get rid of the water and clean the bath promptly when finished. The child should be dabbed dry with a soft towel, and put back to bed. Do not rub the body vigorously, for this may break the blisters and encourage added infection, which may prolong convalescence.
If the itch is maddening, relief may be given in the form of the many antipruritic (anti-itch) lotions and creams readily available from the pharmacist. Apply if and when the itch becomes particularly trying. The warmth of the bed or of heaters may aggravate itching.
If there are obvious skin infections, antibiotics in the form of ointments for local use, and occasionally capsules by mouth, may be prescribed by the doctor. Call the doctor if there are any aspects that worry you, or if the disorder is not responding fairly well to simple home remedies.
Occasionally, mixtures (for infants) or tablets (for older children) may be required to reduce elevated temperatures and relieve pain and discomfort. Paracetamol elixir is effective. It is readily available at pharmacists, and dosage is usually written on the label (it varies with age). Paracetamol or aspirin tablets are suitable for children aged 6 years or older. The dosage is usually on the label for these too, and varies with age.
Complications are unusual, except skin scarring from large blisters, especially if they become infected. On very rare occasions, viral encephalitis (a viral brain infection) may occur, which is extremely serious. A return to normal with most cases of chicken pox is the usual rule.
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