What is the management of chicken pox in children?

From the Guidelines

The management of chickenpox in children primarily focuses on symptom relief while the infection runs its course, with vaccination being the best prevention method, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. The natural history of chickenpox in children typically involves a self-limiting illness with a rash, fever, and itching, but can lead to complications such as secondary infections, pneumonia, and encephalitis in severe cases. To manage symptoms, the following steps can be taken:

• Start with acetaminophen (10-15 mg/kg every 4-6 hours, maximum 5 doses per day) to reduce fever and discomfort, avoiding aspirin due to the risk of Reye's syndrome.
• For itching, give diphenhydramine (Benadryl) at 1-2 mg/kg every 4-6 hours as needed (maximum 50 mg per dose for children).
• Keep the child's fingernails short and clean to prevent secondary infections from scratching.
• Calamine lotion can be applied to soothe itchy lesions, and cool baths with colloidal oatmeal may provide relief.
• Ensure the child stays well-hydrated and gets plenty of rest. In severe cases or for immunocompromised children, antiviral medication like acyclovir (20 mg/kg four times daily for 5 days, maximum 800 mg per dose) may be prescribed if started within 24 hours of rash onset, as supported by studies on the prevention of varicella 1. Children should be kept home from school until all lesions have crusted over, typically 5-7 days after rash onset, to prevent transmission. Vaccination is the most effective prevention method, with the first dose recommended at 12-15 months and the second at 4-6 years of age, as stated in the recommendations for the prevention of varicella 1.

From the FDA Drug Label

Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox. There is no information about the efficacy of therapy initiated more than 24 hours after onset of signs and symptoms

The management of chicken pox in children involves antiviral therapy with acyclovir. The recommended dose is:

• For children 2 years of age and older: 20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days
• For children over 40 kg: 800 mg 4 times daily for 5 days Therapy should be initiated at the earliest sign or symptom of chickenpox. The efficacy of therapy initiated more than 24 hours after onset of signs and symptoms is unknown 2

From the Research

Management of Chicken Pox in Children

The management of chicken pox in children involves various strategies to prevent and treat the infection.

• Prevention of chicken pox can be achieved through vaccination, with the live attenuated vaccine being effective in preventing the disease 3.
• For children exposed to chicken pox, post-exposure prophylaxis with varicella zoster immune globulin (VARIZIG) can be used to prevent or attenuate the infection, especially in immunocompromised individuals 4.
• Antiviral medications such as acyclovir can be used to treat chicken pox in children, particularly those with severe infections or those who are immunocompromised 5, 6.
• Nursing management of childhood chickenpox infection involves recognizing the signs and symptoms of the disease, providing supportive care, and monitoring for potential complications such as pneumonia, central nervous system infection, and secondary bacterial infections 7.

Treatment of Chicken Pox in Children

The treatment of chicken pox in children depends on the severity of the infection and the individual's immune status.

• For immunocompetent children, treatment is usually focused on relieving symptoms such as fever and itching, and preventing complications 7.
• For immunocompromised children, antiviral medications such as acyclovir may be necessary to treat the infection, and hospitalization may be required in severe cases 4, 6.
• The use of acyclovir prophylaxis as an adjunctive measure to VARIZIG can help prevent varicella infection in children receiving steroids 5.

Prevention of Chicken Pox in Children

Prevention of chicken pox in children can be achieved through vaccination and post-exposure prophylaxis.

• The live attenuated vaccine is effective in preventing chicken pox, and is recommended for all children 3.
• VARIZIG can be used to prevent or attenuate chicken pox in children who are exposed to the virus, particularly those who are immunocompromised 4.
• Acyclovir prophylaxis can also be used to prevent varicella infection in children exposed to the virus, especially those with renal disease receiving steroids 5.