Shingles (Herpes Zoster) in Children
What is shingles in children?Shingles (herpes zoster) is a painful skin rash. It’s caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox.
What causes shingles in a child?After a person has chickenpox, the virus stays in the body’s nerve cells but is inactive. Years later, the varicella-zoster virus can become active again. The virus can then cause a red rash or small blisters, usually on one side of the body. The rash or blisters spread along a nerve pathway where the virus was living.
Which children are at risk for shingles?
Shingles in children is not common. A child is more at risk for shingles if either of these are true:
- He or she had chickenpox before age 1
- The child’s mother had chickenpox very late in pregnancy
Children who get the chickenpox vaccine still have a small risk for shingles. But it may be a lower risk than after a chickenpox infection. And the symptoms may be less severe. The risk of shingles increases with age. A child with a weak immune systems may have the same, or more severe, symptoms as an adult.
What are the symptoms of shingles in a child?
The symptoms start with pain, burning, tingling, or itching on one part of the face or body. The rash can appear up to 5 days after these symptoms.
The shingles rash most often occurs on the torso and buttocks. It may also appear on the arms, legs, or face. The rash starts as small, red spots that turn into blisters. The blisters turn yellow and dry. The rash is usually only on one side or part of the body. It goes away in 2 to 4 weeks.
Your child may also have symptoms such as:
- Fever and chills
The symptoms of shingles can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How is shingles diagnosed in a child?
The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:
- Skin scrapings. The blisters are gently scraped to remove tiny samples. The samples are examined to look for the virus.
- Blood tests. These are to check for signs of virus in the blood.
How is shingles treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Treatment right away with antiviral medicine may help lessen how long the symptoms last and how serious they are. These antiviral medicines work better the sooner they are started. Your child may be given acyclovir, famcyclovir, or valacyclovir. Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.
Ask the healthcare provider about over-the-counter pain medicine. You may be able to give acetaminophen or ibuprofen for fever and discomfort. Don't give ibuprofen to a child younger than 6 months old, unless your healthcare provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.
If your child’s pain is severe, the healthcare provider may prescribe stronger pain medicine.
What are possible complications of shingles in a child?After the shingles rash is gone, the pain may continue for a long time. This is a complication called postherpetic neuralgia (PHN). Talk with the healthcare provider if your child’s pain stays after the rash goes away.
How can I help prevent shingles in my child?There is a shingles vaccine for older adults, but not for children. This is because shingles is more severe in older adults. But a child who has had the chickenpox vaccine may have milder symptoms of shingles. If your child has not had chickenpox, talk with the healthcare provider about the chickenpox vaccine.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Symptoms that don’t get better, or get worse
- New symptoms
Key points about shingles in children
- Shingles (herpes zoster) is a painful skin rash. It’s caused by the virus that causes chickenpox.
- Shingles in children is not common.
- The symptoms start with pain, burning, tingling, or itching on one part of the face or body. The virus can then cause a red rash or small blisters, usually on one side of the body.
- Treatment right away with antiviral medicine may help lessen how long the symptoms last and how serious they are.
- If your child’s pain is severe, the healthcare provider may prescribe strong pain medicine.
- There is a shingles vaccine for older adults, but not for children. But a child who has had the chickenpox vaccine may have milder symptoms of shingles.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
May 21, 2017
Baker, CJ. Red Book Atlas of Pediatric Infectious Diseases (2013); 2nd ed., Diagnosis of varicella-zoster virus infection, Up To Date, Epidemiology and pathogenesis of varicella zoster virus infection, Up To Date, Up To Date. Clinical Manifestations of Varicella-Zoster Virus Infection: Herpes Zoster, Vaccination for the prevention of shingles, Up To Date
Freeborn, Donna, PhD, CNM, FNP,Lentnek, Arnold, MD