Chicken pox of 2.t year old child, signs and symptoms with treatment
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varicella chickenpox children treatment
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Chickenpox (Varicella) in a 2-Year-Old Child
What Is It?
Chickenpox is an acute, highly infectious disease caused by Varicella-Zoster Virus (VZV) - also called Human (alpha) Herpesvirus 3. It primarily affects children under 10 years of age. In a 2-year-old, it is typically mild and self-limiting, though still uncomfortable and contagious.
Incubation Period
14-16 days (range: 10-21 days) after exposure to an infected person.
Signs & Symptoms
1. Prodromal Stage (Pre-Eruptive, lasts ~24 hours)
In young children like a 2-year-old, prodromal symptoms are often minimal or absent. When present, they include:
- Mild to moderate fever (temperature rises with each new crop of lesions)
- Malaise (general unwell feeling)
- Backache
- Loss of appetite
- Mild headache, chills
Note: In adults, the prodrome is more severe and lasts 2-3 days - but in toddlers the rash is often the first sign, appearing the same day as fever.
2. Eruptive Stage (The Rash)
The rash is the hallmark of chickenpox and has very distinctive features:
| Feature | Description |
|---|---|
| First site | Face and scalp, spreads to trunk (most dense there), then extremities |
| Distribution | Centripetal - trunk abundant, limbs less so; axillae affected; palms and soles usually spared |
| Mucosal | Mouth, nose, pharynx - vesicles rupture quickly, leaving shallow 2-3 mm ulcers |
| Number of lesions | Average 250-500 lesions in healthy children |
| Progression | Macule → Papule → Vesicle → Pustule → Crust (within 12-24 hours per lesion) |
Key hallmark appearance: The early vesicle looks like a "dewdrop on a rose petal" - a 2-3 mm thin-walled blister surrounded by irregular erythema (redness).
The most diagnostic feature: Lesions in ALL stages simultaneously in the same area - this is because they appear in successive crops over several days (3-5 crops over 2-4 days).
Crusting: Scabs form 4-7 days after the rash appears and fall off in 1-3 weeks.
3. Fever
- Rises with each fresh crop of rash
- Proportional to rash severity
- May reach 40.5°C (105°F) in severe cases
- Prolonged or recurrent fever may signal secondary bacterial infection
4. Pruritus (Itching)
- Usually the most distressing symptom for the child
- Present until all lesions are crusted
- Scratching can lead to scarring and bacterial superinfection
Complications (to Watch For)
In an otherwise healthy 2-year-old, complications are rare, but parents should be aware:
| Complication | Notes |
|---|---|
| Secondary bacterial infection | Most common complication in children - from scratching (Staph aureus, Group A Strep) - can cause cellulitis, impetigo |
| Acute cerebellar ataxia | Child appears unsteady/clumsy; usually resolves |
| Encephalitis | Rare; presents with altered consciousness, seizures |
| Reye's Syndrome | Acute encephalopathy + liver fatty degeneration - linked to aspirin use in varicella |
| Varicella pneumonia | Rare in healthy children; more common in neonates, adults, immunocompromised |
| Pitted scars | Frequent if lesions are scratched or superinfected |
Treatment
A. Supportive Care (for all healthy children including 2-year-olds)
| Measure | Details |
|---|---|
| Fever | Paracetamol (acetaminophen) - NEVER aspirin (risk of Reye's syndrome) |
| Itching | Oral antihistamines (e.g., chlorpheniramine) |
| Topical soothing | Calamine lotion; tepid baths with baking soda or colloidal oatmeal (3 cups per tub) |
| Cool compresses | Applied to itchy lesions |
| Nail hygiene | Keep nails short and clean to minimize scratching and bacterial infection |
| Clothing | Light, loose-fitting clothing to reduce irritation |
| Hydration | Adequate fluids especially if fever is present |
| Oral ulcers | Soft, cool foods; avoid salty or acidic foods |
Do NOT use topical steroids or occlusive ointments on lesions.
B. Antiviral Therapy
Per Fitzpatrick's Dermatology (Table 165-3):
For a healthy child aged 2 years:
- Symptomatic treatment alone is often sufficient
- If antivirals are used, they must be started within 24 hours of rash onset to be effective
- Oral Acyclovir: 20 mg/kg (up to 800 mg) orally 4 times daily for 5 days
- Valacyclovir: 20 mg/kg every 8 hours for 5 days (not exceeding 3 g/day)
In routine healthy toddlers, antivirals are not automatically recommended as varicella is generally benign and self-limiting. They are more strongly indicated in:
- Adolescents and adults
- Children on steroids or inhaled corticosteroids
- Immunocompromised children
- Secondary household cases (who tend to be more severely affected)
IV Acyclovir (10 mg/kg every 8 hours for 7-10 days) is reserved for:
- Varicella pneumonia
- Encephalitis
- Severely immunocompromised patients
C. Treating Bacterial Superinfection
- Minor bacterial infections: warm soaks
- Bacterial cellulitis: systemic antibiotics effective against Staph aureus and Group A beta-hemolytic Streptococcus
Isolation & Infectivity
- A child with chickenpox is contagious from 1-2 days before the rash until all lesions have crusted (typically 5-7 days after rash onset)
- Keep the child home from daycare/school during this period
- Secondary attack rate in household contacts is ~85%
Vaccination (Prevention)
- Live attenuated varicella vaccine is recommended for children 12-18 months of age
- Two-dose schedule recommended
- Combined MMRV vaccine can be given from 9 months to 12 years
- Breakthrough infections in vaccinated children do occur but are much milder (usually fewer than 50 lesions, minimal systemic symptoms)
When to Seek Emergency Care
Take the child to the doctor/emergency room immediately if:
- Fever over 39°C (102°F) that does not respond to paracetamol
- Lesions appear to be spreading rapidly or becoming very red, warm, or swollen (bacterial infection)
- Child is very drowsy, confused, or has seizures (encephalitis)
- Child has difficulty walking or appears unsteady (cerebellar ataxia)
- Breathing difficulty (pneumonia)
- Rash in or near the eye
Sources: Fitzpatrick's Dermatology 9th Ed., pp. 3068-3081; Park's Textbook of Preventive and Social Medicine, pp. 163-165; Textbook of Family Medicine 9th Ed., p. 926
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