Chickenpox in Children: Symptoms, How It Starts, and Why It Is Dangerous

Chickenpox, or varicella, is an infection caused by the varicella-zoster virus. It mainly affects children, and in most of them the disease resolves on its own within 1–2 weeks. In infants, adolescents, pregnant women, and people with weakened immunity, the course can be severe.

What chickenpox is and how it is transmitted

The causative agent is the varicella-zoster virus, also known as human herpesvirus type 3, which later causes shingles. Transmission occurs by airborne droplets and through direct contact. Contagiousness is extremely high: everyone who has not previously encountered the virus becomes ill. The incubation period is from 10 to 21 days, more often 14–16 days. A child becomes contagious 48 hours before the rash appears and remains contagious until all lesions are covered with crusts, usually 7–10 days. About half of children contract it at ages 5–9, and about 10% of those affected are older than 14 years.

How chickenpox starts in children: first signs

A prodromal period may occur 1–2 days before the rash appears, but in children it is often absent: the disease begins directly with the rash. In adults, this period may involve fever and malaise. The temperature often rises together with the mass appearance of lesions. The eruptions occur in waves, so fever may be undulating. The rash usually first appears on the face, chest, and back, then spreads over the body.

Main symptoms of varicella in a child

The main sign is an itchy maculopapular rash. It can be anywhere, including the oral mucosa and the skin around the genitals, where it may be painful. The rash goes through three stages: macules, then fluid-filled vesicles that itch intensely and may rupture, then crusts. New macules appear while others turn into vesicles or heal. The color of the lesions is red, pink, darker than or the same as the surrounding skin; on brown and black skin they are harder to notice.

• high temperature;
• pain and aching, general malaise;
• loss of appetite;
• headache and fatigue.

Usually the disease lasts 5–10 days and resolves within 1–2 weeks.

Features of chickenpox in infants and babies

Infants belong to the group that experiences chickenpox more severely. In newborns, morbidity and mortality are higher than in older children. A separate situation is neonatal varicella: if the mother becomes infected 5 days before delivery or in the first 2 days after, in 30% of cases this leads to the death of the newborn. In infants in the first years of life, the prodromal period is often absent, and the first sign parents see is the rash and a rise in temperature.

Possible complications

In most children, varicella is mild, but complications do occur. These include bacterial skin infection, pneumonia, bronchitis, middle ear inflammation, hepatitis, and neurological disorders. Neurological complications are recorded in 1–7.5% of cases, of which encephalitis accounts for 70.5% and meningitis for 10.6%. Mortality in varicella encephalitis is 1–20%, and they account for a quarter of all childhood encephalitis cases. In adults, mortality is 25–175 times higher than in children. After the illness, the virus remains in the body: in 10–20% of those who have had it, it persists inactive in nervous tissue and may later cause shingles.

When to see a doctor

In most cases, chickenpox resolves on its own within 1–2 weeks without a doctor's visit. But in some people it is severe, so a doctor's assessment is needed for infants, adolescents, pregnant women, and children with weakened immunity. The doctor assesses the general condition, the nature and extent of the rash, age, and risk factors, and decides whether antiviral treatment is needed.

Chickenpox itself is not a reason to call an ambulance. You should call 103 or 112 if the child has difficulty breathing, does not respond to being addressed or has confused consciousness, has seizures, or if the condition deteriorates sharply and rapidly.

This material is for reference: it describes the signs and possible complications but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer