From the Guidelines
The treatment for chickenpox in children primarily focuses on relieving symptoms while the virus runs its course, and in severe cases or for high-risk children, antiviral medications like acyclovir may be prescribed, which works best when started within 24 hours of rash appearance, as recommended by recent studies 1.
General Management
The management of chickenpox in children involves relieving symptoms and preventing complications. Start with acetaminophen (Tylenol) for fever and discomfort, giving the appropriate dose based on your child's weight (typically 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) 1. Never give aspirin to children with chickenpox as it can cause Reye's syndrome, a serious condition. For itching, give diphenhydramine (Benadryl) orally (1 mg/kg every 6 hours, not exceeding 50 mg per dose) or apply calamine lotion to soothe the skin.
Prevention of Complications
Keep your child's fingernails short and clean to prevent scratching that can lead to infection and scarring. Lukewarm baths with colloidal oatmeal can provide relief, but avoid hot water which worsens itching. Ensure your child stays hydrated and gets plenty of rest. In cases of exposure to chickenpox, prophylactic treatment with oral acyclovir (10 mg/kg four times a day for 7 days) within 7–10 days of exposure to chickenpox may be recommended for susceptible patients, as suggested by recent guidelines 1.
High-Risk Children
In severe cases or for high-risk children (those with weakened immune systems), a doctor may prescribe antiviral medications like acyclovir, which works best when started within 24 hours of rash appearance. Contact a doctor if your child develops high fever, difficulty breathing, severe headache, or if the rash becomes very red, warm, or leaks pus, as these may indicate complications requiring medical attention. The use of varicella vaccine has been shown to be effective in preventing varicella disease and its complications, with a significant reduction in varicella incidence, hospitalizations, and deaths since its implementation 1.
Key Considerations
- Vaccination: Varicella vaccine is an effective prevention tool for decreasing the burden attributable to varicella disease and its complications in the United States, with a recommended routine 2-dose varicella immunization schedule for children 1.
- Antiviral Treatment: Antiviral medications like acyclovir may be prescribed for severe cases or high-risk children, and work best when started within 24 hours of rash appearance 1.
- Symptom Relief: Relieving symptoms and preventing complications are key components of chickenpox management in children, including the use of acetaminophen, diphenhydramine, and calamine lotion 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.
The recommended treatment for chickenpox in children is:
- For children 2 years of age and older, weighing less than 40 kg: 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, which is the same as the adult dose. Therapy should be initiated at the earliest sign or symptom of chickenpox 2.
From the Research
Treatment Options for Chickenpox in Children
- 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 the drug of choice for varicella and herpes zoster, and its clinical impact is related directly to its use early in the clinical course 4.
- The route of administration of acyclovir may be intravenous or oral, depending on the immunocompetence of the host 4.
Effectiveness of Treatment
- A systematic review found six studies that met the inclusion criteria, and the results showed that aciclovir is effective in treating chickenpox in healthy adults and children, including neonates, within 24 hours after onset of rash 5.
- The review also found that aciclovir is effective in treating chickenpox in immunocompromised adults and children, including neonates 5.
- The use of corticosteroids in the treatment of chickenpox remains an open dilemma 3.
New Antiviral Agents
- Novel anti-VZV drugs have recently been evaluated in clinical trials, including the bicyclic nucleoside analog FV-100, the helicase-primase inhibitor ASP2151, and valomaciclovir (prodrug of the acyclic guanosine derivative H2G) 6.
- Helicase-primase inhibitors (HPIs) such as pritelivir and amenamevir have novel mechanisms of action, drug resistance properties, pharmacokinetic characteristics, and clinical efficacy for treating genital herpes and herpes zoster 7.