What are the symptoms and treatment options for Varicella (chickenpox) in pediatric patients?

From the Guidelines

Chickenpox in children should be managed with supportive care, including acetaminophen for fever and discomfort, and the varicella vaccine is recommended at 12-15 months with a booster at 4-6 years to prevent the disease and its complications. The varicella-zoster virus is highly contagious and typically resolves on its own within 1-2 weeks. For symptom management, give children acetaminophen (Tylenol) at appropriate weight-based dosing (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) to reduce fever and discomfort, as recommended by various studies 1. Avoid aspirin due to the risk of Reye's syndrome. Keep children hydrated and prevent scratching by trimming nails short, using calamine lotion on itchy spots, giving diphenhydramine (Benadryl) for itching (1-1.25 mg/kg every 6 hours), or adding colloidal oatmeal to lukewarm baths.

Some key points to consider in managing chickenpox in children include:

• Keeping children hydrated to prevent dehydration
• Preventing scratching to reduce the risk of secondary bacterial infections
• Watching for signs of secondary bacterial infection like increasing redness, warmth, swelling, or pus around lesions, which would require medical attention
• Children should stay home until all blisters have crusted over, typically 5-7 days after rash onset

The varicella vaccine has been shown to be highly effective in preventing chickenpox and its complications, with a dramatic reduction in cases and hospitalizations since its introduction 1. The vaccine is recommended at 12-15 months with a booster at 4-6 years, and has been shown to provide long-term immunity against the disease. The virus remains dormant in nerve cells after recovery and may reactivate later in life as shingles. Overall, the varicella vaccine is a highly effective and safe way to prevent chickenpox and its complications in children.

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. Three randomized, double-blind, placebo-controlled trials were conducted in 993 pediatric patients aged 2 to 18 years with chickenpox. All patients were treated within 24 hours after the onset of rash In 2 trials, Acyclovir Tablets was administered at 20 mg/kg 4 times daily (up to 3,200 mg per day) for 5 days. Treatment with Acyclovir Tablets shortened the time to 50% healing; reduced the maximum number of lesions; reduced the median number of vesicles; decreased the median number of residual lesions on day 28; and decreased the proportion of patients with fever, anorexia, and lethargy by day 2

The recommended dose of acyclovir for chickenpox in children is 20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Treatment should be initiated within 24 hours after the onset of rash. Acyclovir has been shown to be effective in reducing the severity and duration of chickenpox symptoms in pediatric patients 2. The dosage for children over 40 kg is the same as the adult dose 2.

From the Research

Chicken Pox in Children: Overview

• Chicken pox is a highly contagious childhood disease caused by the varicella-zoster virus primary infection 3, 4, 5.
• It is characterized by an itchy vesicular rash and fever, which usually resolves spontaneously without medical intervention 4.

Symptoms and Complications

• Symptoms can range from mild to moderate, but severe cases can have more than 1000 lesions and severe constitutional symptoms 5.
• Serious complications can occur, including pneumonia, central nervous system infection, overwhelming secondary bacterial infections, and necrotizing fasciitis 4.

Treatment and Management

• Symptomatic therapy is usually adequate for chickenpox, but in some cases, it requires combinations of antiviral drugs and antibiotics 3.
• Antiviral therapy, such as acyclovir, is effective in preventing complications of varicella-zoster virus infection, especially in immunocompromised patients 6.
• Vaccination is available and is about 80-85% effective against all disease and highly (more than 95%) effective in prevention of severe disease 5.

Nursing Management

• Emergency department nurses should be able to recognize the signs and symptoms that indicate deterioration in children with chickenpox 4.
• School nurses play a crucial role in promoting optimal health and wellness, including educating students and parents about chickenpox prevention and management 7.