Treatment of Chickenpox in Children
For otherwise healthy children with chickenpox, supportive care alone is the recommended treatment, as antiviral therapy with acyclovir is not routinely indicated in immunocompetent children with uncomplicated varicella infection. 1, 2
Supportive Care Measures
Symptomatic management is the cornerstone of treatment for healthy children with chickenpox:
- Relieve itching with lukewarm baths containing colloidal oatmeal 1
- Avoid aspirin and salicylates for 6 weeks after varicella infection due to the risk of Reye syndrome 3
- Monitor for complications, particularly bacterial superinfections (the most common complication requiring hospitalization), which present as expanding erythema around lesions, purulent drainage, increasing pain, or systemic toxicity 1, 3
- Expect resolution within 5-7 days in most uncomplicated cases 1
When Antiviral Therapy IS Indicated
Oral acyclovir should be considered in specific high-risk situations:
High-Risk Groups Requiring Treatment 4, 2
- Immunocompromised children (require IV acyclovir, not oral) 1, 2
- Infants under 1 year (6 times higher hospitalization risk than older children) 1
- Children with chronic skin disorders or serious cardiopulmonary disease where varicella may exacerbate the underlying condition 2
- Severe varicella in any patient 2
Dosing When Indicated 4
- Children 2 years and older: 20 mg/kg per dose orally 4 times daily (maximum 80 mg/kg/day) for 5 days 4
- Children over 40 kg: 800 mg orally 4 times daily for 5 days 4
- Timing is critical: Therapy must be initiated within 24 hours of rash onset for effectiveness 4, 5
Important caveat: A landmark controlled trial in 815 healthy children demonstrated that while acyclovir reduced lesion count, duration of fever, and time to healing, it did not significantly reduce serious complications in otherwise healthy children, which is why routine use is not recommended 5
Isolation and Prevention of Spread
- Keep the child isolated until all lesions have crusted over (typically 5-7 days after rash onset) 1
- Susceptible household contacts should receive varicella vaccine within 3 days of exposure (>90% effective at preventing disease) or within 5 days (70% effective at preventing disease, 100% effective at modifying severity) 1, 6
- Household contacts have the highest infection risk (approximately 85% attack rate), making post-exposure vaccination particularly important 3
Future Vaccination
- Once recovered, no varicella vaccination is needed as natural infection provides lifelong immunity 6
- For unvaccinated children who haven't had chickenpox, administer the first dose at 12-15 months and second dose at 4-6 years 6
Red Flags Requiring Immediate Evaluation
Watch for these serious complications that may require hospitalization or IV acyclovir: