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Children’s Health and Back to School

Thursday, August 8, 2019

Returning to school after holidays is an optimum time for the passing of bacteria, viruses and bugs.

Children are wonderful and bring joy with their vivaciousness and smiles. However, this dwindles when they are unwell. A child’s immune system is comprised of tissues, organs and cells that work to attack invaders and defend them against germs. Unfortunately it is not always 100% effective, so periods of illness can occur. Returning to school after holidays is an optimum time for the passing of bacteria, viruses and bugs.

Below are some common childhood illnesses/conditions. Their treatments are discussed along with hints and tips and guidance on the length of time (if any) the child should be absent from school/nursery.

Head Lice – ‘Nits’

Head lice are parasitic insects called Pediculus humanus capitis. They only live on the heads of people. Fully grown adult lice are approximately 3mm long. Head lice and nits are very common in young children and their families. They do not have anything to do with dirty hair and are picked up by head-to-head contact.

The only way to be sure someone has head lice is by finding live lice.

Treat head lice as soon as you spot them. You should check everyone in the house and start treating anyone who has head lice on the same day.

Treatment

Wet combing

Lice and nits can be removed by wet combing. You should try this method first.

You can buy a special fine-toothed comb (detection comb/bone comb) from the pharmacy to remove head lice and nits.

There may be instructions on the pack, but usually you:

• wash hair with ordinary shampoo
• apply lots of conditioner (any conditioner will do)
• comb the whole head of hair, from the roots to the ends

It usually takes about 10 minutes to comb short hair, and 20 to 30 minutes for long, frizzy or curly hair.

Do wet combing on days 1, 5, 9 and 13 to catch any newly hatched head lice. Check again that everyone's hair is free of lice on day 17.

Medicated lotions and sprays

Ask a pharmacist for advice if you have tried wet combing for 17 days, but your child still has live head lice.

They may recommend using medicated lotions and sprays. These kill head lice in all types of hair, and you can buy them from the pharmacy or online.

Head lice should die within a day. Some lotions and sprays come with a comb to remove dead lice and eggs.

Some treatments need to be repeated after a week to kill any newly hatched lice.

Your local pharmacist will utilize their expertise to guide you.

If lotions or sprays do not work, speak to a pharmacist about other treatments.

Some treatments are not recommended because they're unlikely to work. For example:

• products containing permethrin
• head lice "repellents"
• electric combs for head lice
• tree and plant oil treatments, such as tea tree oil, eucalyptus oil and lavender oil herbal remedies

 

You cannot prevent head lice

You can help stop them spreading by wet or dry combing regularly to catch them early.

Do not use medicated lotions and sprays to prevent head lice. They can irritate the scalp.

There's no need for children to stay off school/nursery but they should be informed. 

 

Threadworm/Pinworms

Threadworms are common but are not usually serious. Threadworms infect the gut and lay eggs around your anus which causes itch. They are small, thin, white, thread-like worms between 2 mm and 13 mm long. You can spot worms in your poo. They look like pieces of white thread.

You might also see them around your child's bottom (anus). The worms usually come out at night while your child is sleeping. Threadworms spread when their eggs are swallowed. The eggs get stuck on your fingers when you scratch, particularly with itch around the anus. They can then pass on to anything you touch, including:

• clothes
• toys
• toothbrushes
• kitchen or bathroom surfaces
• bedding
• food
• pets

Eggs can then pass to other people when they touch these surfaces and touch their mouth. They take around 2 weeks to hatch.

Children can get worms again after they've been treated for them if they get the eggs in their mouth.

Treatment

All household members, including adults and those without symptoms, should be treated. This is because many people with threadworm infection do not have any symptoms. However, they will still pass out eggs which can then infect other people. If one member of a household is infected, it is common for others also to be infected. So, everyone needs treatment!

Threadworms are usually treated with a chewable tablet or oral liquid. They can be easily treated in the pharmacy. Please alert pharmacist if anyone requiring treatment is pregnant, breast feeding or under 2 years of age.

Medicine kills the threadworms, but it does not kill the eggs. Eggs can live for up to 2 weeks outside the body.

There are things you can do to stop becoming infected again.

• wash hands and scrub under fingernails – particularly before eating, after using the toilet or changing nappies
• encourage children to wash hands regularly
• bath or shower every morning
• rinse toothbrushes before using them
• keep fingernails short
• wash sleepwear, sheets, towels and soft toys (at normal temperature)
• disinfect kitchen and bathroom surfaces
• vacuum and dust with a damp cloth
• make sure children wear underwear at night – change it in the morning
• do not shake clothing or bedding, to prevent eggs landing on other surfaces
• do not share towels or flannels
• do not bite nails or suck thumbs and fingers

There's no need for children to stay off school/nursery but they should be informed.

Scabies

Scabies is a common and very itchy skin condition caused by a tiny mite called Sarcoptes Scabiei. It can affect people of any age but is most common in the young and the elderly. The mites that cause scabies are tiny parasites, smaller than a pinhead. They are usually spread by direct skin-to-skin contact with someone who already has scabies and sometimes, but rarely, from shared clothing, towels or bedding. 

Itching is the main symptom of scabies, usually starting about a month after the mites are picked up. The itching can affect the whole body apart from the head and neck, although the elderly and infants may develop a rash on their head and neck. The itch often gets worse at night. It is common for several people in the same family, and their friends, to become itchy at roughly the same time. 

The rash of scabies is a mixture of scratch marks and tiny red spots; scratched areas may develop crusty sores which can become infected and develop into small pus spots. A widespread rash similar to eczema (dermatitis) is very common. The itchy rash can cover much of the body, but the mites are found mainly in the folds of skin between fingers and toes, the palms of the hands, the wrists, ankles and soles of the feet, groins and breasts. The scabies mites burrow into the skin in these areas to lay their eggs. The mites burrow into the skin leaving tiny spots and silver coloured lines on the skin. Adult mites are tiny, only about 0.4 mm long.

Treatment

Scabies are usually treated with creams or lotion. Guidance on the application will be given by your pharmacist but also readily available on the packaging of the product selected to treat. Other advice includes-

• wash all bedding and clothing in the house at 50C or higher on the first day of treatment
• put clothing that cannot be washed in a sealed bag for 3 days until the mites die
• stop babies and children sucking treatment from their hands by putting socks or mittens on them

• do not have sex or close physical contact until you have completed the full course of treatment
• do not share bedding, clothing or towels with someone with scabies

Children should stay off school/nursery until after their first treatment with mediation (cream/lotion).

Slapped Cheek

Slapped cheek syndrome (also called fifth disease or parvovirus B19) is a viral infection that's most common in children, although it can affect people of any age. It usually causes a bright red rash on the cheeks. The virus is found in the droplets in the coughs and sneezes of someone with the infection.

The virus is spread in a similar way to colds and flu. 

Although the rash can look alarming, slapped cheek syndrome is normally a mild infection that clears up by itself in one to three weeks. Once you've had the infection, you're usually immune to it for life.

Symptoms of slapped cheek syndrome usually develop 4-14 days after becoming infected, but sometimes may not appear for up to 21 days.

Some people with slapped cheek syndrome won't notice any early symptoms, but most people will have the following symptoms for a few days:

• a slightly high temperature (fever) of around 38C (100.4F)
• a runny nose 
• a sore throat
• a headache
• an upset stomach
• feeling generally unwell

After a few days, a distinctive bright red rash on both cheeks (the so-called "slapped cheeks") normally appears. After another few days, a light pink rash may also appear on the chest, stomach, arms and thighs. This often has a raised, lace-like appearance and may be itchy.

The rashes will normally fade within a week or two, although occasionally the body rash may come and go for a few weeks after the infection has passed. This can be triggered by exercise, heat, anxiety or stress.

Treatment

Slapped cheek syndrome is usually mild and should clear up without specific treatment.

If you or your child is feeling unwell, you can try the following to ease the symptoms:

• rest and drink plenty of fluids – babies should continue their normal feeds
• for a fever, headaches or joint pain, you can take painkillers, such as paracetamol or ibuprofen – children under 16 shouldn't take aspirin
• to reduce itchiness, you can take antihistamines or use an emollient (moisturising lotion) – some antihistamines are not suitable for young children, so check with your pharmacist first

 

Unless you or your child is feeling unwell, there’s no need to stay away from school or work once the rash has developed, as the infection is no longer contagious by this point. It’s a good idea to notify your child's school about the infection, so children who develop early symptoms can be spotted quickly and vulnerable people (pregnant females, patients with severe anaemia and patiens with blood disorder) can be made aware that they may need to get medical advice.

There's no need for children to stay off school/nursery after rash develops, but they should be informed.

 

Hand, Foot and Mouth

Hand, foot and mouth disease is a common infection that causes mouth ulcers and spots on the hands and feet.

It's most common in young children – particularly those under 10 – but can affect older children and adults as well.

The symptoms of hand, foot and mouth disease usually develop between three and five days after being exposed to the infection.

The first symptoms may include:

• a high temperature (fever), usually around 38-39C
• a general sense of feeling unwell/malaise
• loss of appetite
• coughing
• abdominal (tummy) pain
• a sore throat and mouth 

Mouth ulcers

After one or two days, red spots appear on the tongue and inside the mouth.

These quickly develop into larger yellow-grey mouth ulcers with red edges.

The ulcers can be painful and make eating, drinking and swallowing difficult. They should pass within a week.

Spotty rash and blisters

Soon after the mouth ulcers appear, you'll probably notice a rash made up of small, raised red spots on the skin.

These typically develop on the fingers, the backs or palms of the hand, the soles of the feet, and occasionally on the buttocks and groin.

The spots may then turn into small blisters with a grey centre.

The spots and blisters can sometimes be itchy or uncomfortable and typically last up to 10 days.

Treatment

You don't usually need medical attention if you think you or your child has hand, foot and mouth disease. The infection will usually pass in 7 to 10 days.

Antibiotics won't help as hand, foot and mouth disease is caused by a virus.

To help ease you or your child's symptoms:

• drink plenty of fluids to avoid dehydration– water or milk are ideal; it may help to give a baby smaller but more frequent bottle or breast milk feeds
• eat soft foods such as mashed potatoes, yoghurt and soups if eating and swallowing is uncomfortable – avoid hot, acidic or spicy foods and drinks
• take over-the-counter painkillers, such as paracetamol or ibuprofen, to ease a sore throat and fever – aspirin shouldn't be given to children under the age of 16; paracetamol is best if you're pregnant
• try gargling with warm, salty water to relieve discomfort from mouth ulcers – it's important not to swallow the mixture, so this isn't recommended for young children
• alternatively, use mouth gels, rinses or sprays for mouth ulcers – these are available from pharmacies, but aren't routinely recommended, and some aren't suitable for young children; ask your pharmacist for advice.

Someone with hand, foot and mouth disease is most infectious from just before their symptoms start until they're feeling better.

The infection can be spread by close person to person contact and contact with contaminated surfaces. The virus is found in:

• the droplets in the coughs and sneezes of an infected person – you can become infected if you get these on your hands and then touch your mouth, or if you breathe in the droplets
• an infected person's poo – if an infected person doesn't wash their hands properly after going to the toilet, they can contaminate food or surfaces
• an infected person's saliva or fluid from their blisters – you can become infected if this gets in your mouth

The infection is caused by a number of different viruses, so it's possible to get it more than once. Most people develop immunity to these viruses as they get older.

Preventing hand, foot and mouth disease

It's not always possible to avoid getting hand, foot and mouth disease, but following the advice below can help stop the infection spreading.

• Use tissues to cover your mouth and nose when you cough or sneeze and put used tissues in a bin as soon as possible.
• Wash your hands with soap and water often – particularly after going to the toilet, coughing, sneezing or handling nappies, and before preparing food.
• Avoid sharing cups, utensils, towels and clothes with people who are infected.
• Disinfect any surfaces or objects that could be contaminated – it's best to use a bleach-based household cleaner.
• Wash any bedding or clothing that could have become contaminated separately on a hot wash.

There's no need for children to stay off school/nursery but they may not feel well enough to attend. If they are attending, school/nursery should be informed.

Scarlet Fever

Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash.

The illness is caused by Streptococcus pyogenes bacteria, also known as group A streptococcus, which are found on the skin and in the throat.

It’s important to be aware of the signs and symptoms of scarlet fever so that early treatment with antibiotics can be given.

Scarlet fever usually follows a sore throat or a skin infection, such as impetigo, caused by particular strains of streptococcus bacteria.

Initial symptoms usually include a sore throat, headache and a high temperature (38 C or above), flushed cheeks and a swollen tongue.

A day or two later the characteristic pinkish rash appears. It usually occurs on the chest and stomach before spreading to other areas of the body, such as the ears and neck.

The symptoms of scarlet fever usually develop two to five days after infection, although the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as seven days.

The rash feels like sandpaper to touch and it may be itchy.

Scarlet fever is very contagious and can be caught by:

• breathing in bacteria in airborne droplets from an infected person's coughs and sneezes
• touching the skin of a person with a streptococcal skin infection, such as impetigo
• sharing contaminated towels, baths, clothes or bed linen

It can also be caught from carriers – people who have the bacteria in their throat or on their skin but don't have any symptoms.

Most cases (about 80%) of scarlet fever occur in children under 10 (usually between two and eight years of age). However, people of any age can get the illness.

As it's so contagious, scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused by streptococcus bacteria. Outbreaks often occur in nurseries and schools where children are in close contact with one another.

The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins.

It's possible to catch scarlet fever more than once, but this is rare.

Treatment

Scarlet fever used to be a very serious illness, but nowadays most cases tend to be mild.

It can easily be treated with antibiotics. Liquid antibiotics, such as penicillin or amoxicillin, are often used to treat children. These must be taken for 10 days, even though most people recover after four to five days.

Without antibiotic treatment, your child will be infectious for 1-2 weeks after symptoms appear.

There’s currently no vaccine for scarlet fever.

Children and adults should cover their mouth and nose with a tissue when they cough or sneeze and wash their hands with soap and water after using or disposing of tissues.

Avoid sharing contaminated utensils, cups and glasses, clothes, baths, bed linen or towels.

If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment.

Glandular Fever

Glandular fever is a type of viral infection.

It is also known as infectious mononucleosis, or "mono".

Glandular fever is caused by the Epstein-Barr virus (EBV). This virus is found in the saliva of infected people and can be spread through:

• kissing – glandular fever is often referred to as the "kissing disease"
• exposure to coughs and sneezes
• sharing eating and drinking utensils, such as cups, glasses and unwashed cutlery

EBV may be found in the saliva of someone who has had glandular fever for several months after their symptoms pass, and some people may continue to have the virus in their saliva on and off for years.

If you have EBV, it's a good idea to take steps to avoid infecting others while you are ill, such as not kissing other people, but there's no need no need to avoid all contact with others as the chances of passing on the infection are generally low.

Glandular fever can affect people of all ages, but most cases affect teenagers and young adults.

Most EBV infections are thought to occur during childhood and cause only mild symptoms or no symptoms at all.

However, if a person develops an EBV infection during early adulthood, they can develop glandular fever.

Once you have had glandular fever, it is unlikely you will develop it again. This is because people develop lifelong immunity after the initial infection.

Treatment

There is currently no cure for glandular fever, but the symptoms should pass within a few weeks. There are things you can do to help control your symptoms.

Fluids

It is important to drink plenty of fluids (preferably water or unsweetened fruit juice) to avoid dehydration.

Painkillers

Painkillers available over the counter, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, can help reduce pain and fever.

Children under 16 years old should not take aspirin because there is a small risk it could trigger a rare but serious health condition called Reye's syndrome.

Regularly gargling with a solution of warm, salty water may also help relieve your sore throat.

Rest

It is important you take plenty of rest while you recover from glandular fever, although complete bed rest is no longer recommended because it may make the fatigue last longer.

You should gradually increase your activities as your energy levels return, but avoid activities you cannot manage comfortably.

For the first month after your symptoms begin, avoid contact sports or activities that put you at risk of falling. This is because you may have a swollen spleen that it is more vulnerable to damage, and a sudden knock could cause it to burst (rupture).

Antibiotics won't help as glandular fever is caused by a virus.

There's no need for children to stay off school but they should be informed. 

Tonsillitis

Tonsillitis is inflammation of the tonsils. The tonsils are two small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection.

When the tonsils become infected, they isolate the infection and stop it spreading further into the body.

As a child's immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.

Removal of the tonsils is usually only recommended if they're causing problems, such as severe or repeated episodes of tonsillitis (see below).

Tonsillitis is a common condition in children, teenagers and young adults. It's usually caused by a viral infection.

The symptoms of tonsillitis include:

• a sore throatand pain when swallowing
• earache
• high temperature (fever) over 38C (100.4F)
• coughing
• headache

Most cases of tonsillitis are caused by a viral infection, such as the viruses that cause the common cold or flu virus (influenza).

Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.

These types of infections spread easily, so it's important to try to avoid passing the infection on to others by:

• staying away from public places, such as work, school or nursery, until your GP says it's safe to return (usually after the symptoms have passed)
• coughing and sneezing into a tissue and disposing of the tissue 
• washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing

 

The tonsils are two small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection.

When the tonsils become infected, they isolate the infection and stop it spreading further into the body.

As a child's immune system develops and gets stronger, the tonsils become less important and usually shrink. In most people, the body is able to fight infection without the tonsils.

Removal of the tonsils is usually only recommended if they're causing problems, such as severe or repeated episodes of tonsillitis (see below).

Treatment

There's no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:

• taking paracetamolor ibuprofen to help relieve pain
• drinking plenty of fluids
• getting plenty of rest

If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed.

Chronic tonsillitis

In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis and surgical treatment may be needed.

Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if:

• you've had several severe episodes of tonsillitis over a long period of time
• repeated episodes are disrupting normal activities

Antibiotics won't help as tonsillitis is usually caused by a virus.

There's no need for children to stay off school but they should be informed. 

Whooping Cough

Whooping cough, also called pertussis, is a highly contagious bacterial infection of the lungs and airways. It is caused by a bacteria (Bordetella pertussis) and is one of the most contagious bacterial infections.

It causes repeated coughing bouts that can last for two to three months or more, and can make babies and young children in particular very ill.

The first symptoms of whooping cough are similar to those of a cold, such as a runny nose, red and watery eyes, a sore throat, and a slightly raised temperature.

Intense coughing bouts start about a week later.

• The bouts usually last a few minutes at a time and tend to be more common at night.
• Coughing usually brings up thick mucus and may be followed by vomiting.
• Between coughs, you or your child may gasp for breath – this may cause a "whoop" sound, although not everyone has this.
• The strain of coughing can cause the face to become very red, and there may be some slight bleeding under the skin or in the eyes.
• Young children can sometimes briefly turn blue (cyanosis) if they have trouble breathing – this often looks worse than it is and their breathing should start again quickly.
• In very young babies, the cough may not be particularly noticeable, but there may be brief periods where they stop breathing.

Treatment

Treatment for whooping cough depends on your age and how long you've had the infection.

• Children under six months who are very ill and people with severe symptoms will usually be admitted to hospital for treatment.
• People diagnosed during the first three weeks of infection may be prescribed antibioticsto take at home – these will help stop the infection spreading to others, but may not reduce the symptoms.
• People who've had whooping cough for more than three weeks won't normally need any specific treatment, as they're no longer contagious and antibiotics are unlikely to help.

While you're recovering at home, it can help to get plenty of rest, drink lots of fluids, clean away mucus and sick from your or your child's mouth, and take painkillers such as paracetamol or ibuprofen for a fever.

Avoid using cough medicines, as they're not suitable for young children and are unlikely to be of much help.

Stopping the infection spreading

If you or your child are taking antibiotics for whooping cough, you need to be careful not to spread the infection to others.

• Cover your or your child's mouth and nose with a tissue when coughing and sneezing.
• Dispose of used tissues immediately.
• Wash your and your child's hands regularly with soap and water.

Other members of your household may also be given antibiotics and a dose of the whooping cough vaccine to stop them becoming infected.

Vaccinations for whooping cough

There are three routine vaccinations that can protect babies and children from whooping cough:

• the whooping cough vaccine in pregnancy – this can protect your baby during the first few weeks of life; the best time to have it is soon after the 16th week of your pregnancy
• the 5-in-1 vaccine – offered to babies at 8, 12 and 16 weeks of age
• the 4-in-1 pre-school booster – offered to children by 3 years and 4 months

These vaccines don't offer lifelong protection from whooping cough, but they can help stop children getting it when they're young and more vulnerable to the effects of the infection.

Older children and adults aren't routinely vaccinated, except during pregnancy or a whooping cough outbreak.

If your child has whooping cough, keep them away from nursery or school for at least 48 hours after starting treatment with antibiotics.

 

Conjunctivitis

Conjunctivitis is a common condition that causes redness and inflammation of the thin layer of tissue that covers the front of the eye (the conjunctiva).

People often refer to conjunctivitis as red eye.

Other symptoms of conjunctivitis include itchiness and watering of the eyes, and sometimes a sticky coating on the eyelashes (if it's caused by an allergy).

Conjunctivitis can affect one eye at first, but usually affects both eyes after a few hours.

The conjunctiva can become inflamed as a result of:

• a bacterial or viral infection – this is known as infective conjunctivitis
• an allergic reaction to a substance such as pollen or dust mites – this is known as allergic conjunctivitis
• the eye coming into contact with things that can irritate the conjunctiva, such as shampoo or chlorinated water, or a loose eyelash rubbing against the eye – this is known as irritant conjunctivitis

 

Treatment

Treatment isn't usually needed for conjunctivitis, because the symptoms often clear up within a couple of weeks. If treatment is needed, the type of treatment will depend on the cause. In severe cases, antibiotic eye drops can be used to clear the infection.

Irritant conjunctivitis will clear up as soon as whatever is causing it is removed.

Allergic conjunctivitis can usually be treated with anti-allergy medications such as antihistamines. If possible, you should avoid the substance that triggered the allergy.

Speak to a pharmacist about conjunctivitis. They can give you advice and suggest eye drops or antihistamines to help with your symptoms.

It's best not to wear contact lenses until the symptoms have cleared up. Any sticky or crusty coating on the eyelids or lashes can be cleansed with cotton wool and boiled, cooled water.

Washing your hands regularly and not sharing pillows or towels will help prevent it spreading.

There's no need for children to stay off school or nursery but they should be informed. 

Impetigo

Impetigo is a common and highly contagious skin infection that causes sores and blisters. It's not usually serious and often improves within a week of treatment or within a few weeks without treatment.

Impetigo is the most common skin infection in young children in the UK, but it can affect people of all ages. It occurs when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes.

The bacteria can infect the skin in two main ways:

• through a break in otherwise healthy skin – such as a cut, insect bite or other injury – this is known as primary impetigo
• through skin damaged by another underlying skin condition, such as head lice, scabies or eczema – this is known as secondary impetigo

The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels.

As the condition doesn't cause any symptoms until four to 10 days after initial exposure to the bacteria, it's often easily spread to others unintentionally.

There are two types of impetigo:

• non-bullous impetigo – the most common type
• bullous impetigo

Non-bullous impetigo

The symptoms of non-bullous impetigo begin with the appearance of red sores – usually around the nose and mouth but other areas of the face and the limbs can also be affected.

The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin.

After the crusts dry, they leave a red mark that usually fades without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks.

The sores aren't painful, but they may be itchy. It's important not to touch or scratch the sores because this can spread the infection to other parts of the body, and to other people.

Other symptoms, such as a high temperature (fever) and swollen glands, are rare but can occur in more severe cases.

Bullous impetigo

The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the central part of the body between the waist and neck, or on the arms and legs. The blisters are usually about 1-2cm across.

The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring.

The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, it's important not to touch or scratch the affected areas of the skin.

Symptoms of fever and swollen glands are more common in cases of bullous impetigo.

Treatment

Impetigo usually gets better without treatment in around two to three weeks.

However, treatment is often recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of the infection being spread to others.

The main treatments prescribed are antibiotic creams or antibiotic tablets. These usually have to be used for around a week. In many cases, treatment can be supplied by the pharmacist.

During treatment, it's important to take precautions to minimise the risk of impetigo spreading to other people or to other areas of the body.

Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed.

The advice below can also help to prevent the spread of the infection:

• don't share flannels, sheets or towels with anyone who has impetigo – wash them at a high temperature after use
• wash the sores with soap and water and cover them loosely with a gauze bandage or clothing
• avoid touching or scratching the sores, or letting others touch them – it may help to ensure your nails are kept clean and short
• avoid contact with newborn babies, preparing food, playing contact sports, or going to the gym – until the risk of infection has passed
• wash your hands frequently – particularly after touching infected skin
• washable toys should also be washed – wipe non-washable soft toys thoroughly with a cloth that has been wrung out in detergent and warm water and allowed to dry completely

Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. It's important to stay away from work, school, or nursery until this point.

Chickenpox

Chickenpox is a mild and common childhood illness that most children catch at some point.

Chickenpox (known medically as varicella) is caused by a virus called the varicella-zoster virus.

It causes a rash of red, itchy spots that turn into fluid-filled blisters. They then crust over to form scabs, which eventually drop off.

Some children have only a few spots, but other children can have spots that cover their entire body. These are most likely to appear on the face, ears and scalp, under the arms, on the chest and belly, and on the arms and legs. It’s spread quickly and easily from someone who is infected.

Chickenpox is most common in children under the age of 10. In fact, chickenpox is so common in childhood that over 90% of adults are immune to the condition because they've had it before.

Children usually catch chickenpox in winter and spring, particularly between March and May.

Chickenpox is infectious from 1 to 2 days before the rash starts, until all the blisters have crusted over (usually 5 to 6 days after the start of the rash).

If your child has chickenpox, try to keep them away from public areas to avoid contact with people who may not have had it, especially people who are at risk of serious problems, such as newborn babies, pregnant women and anyone with a weakened immune system (for example, people having cancer treatment or taking steroid tablets).

Who's at special risk?

Some children and adults are at special risk of serious problems if they catch chickenpox. They include:

• pregnant women
• newborn babies
• people with a weakened immune system

These people should seek medical advice as soon as they are exposed to the chickenpox virus or they develop chickenpox symptoms.

They may need a blood test to check if they are protected from (immune to) chickenpox.

Read more about immunity testing and the diagnosis of chickenpox in people at special risk.

Chickenpox in pregnancy

Chickenpox occurs in approximately 3 in every 1,000 pregnancies. It can cause serious complications for both the pregnant woman and her baby.

Chickenpox and shingles

Once you have had chickenpox, you usually develop antibodies to the infection and become immune to catching it again. However, the virus that causes chickenpox, the varicella-zoster virus, remains inactive (dormant) in your body's nerve tissues and can return later in life as an illness called shingles.

It's possible to catch chickenpox from someone with shingles, but not the other way around.

Chickenpox in adults

Chickenpox may be a childhood illness, but adults can get it too. Chickenpox tends to be more severe in adults than children, and adults have a higher risk of developing complications.

Adults with chickenpox should stay off work until all the spots have crusted over. They should seek medical advice if they develop any abnormal symptoms, such as infected blisters.

Adults with chickenpox may benefit from taking antiviral medicine if treatment is started early in the course of the illness.

Is there a vaccine against chickenpox?

There is a chickenpox vaccine, but it is not part of the routine childhood vaccination schedule. The vaccine is only offered to children and adults who are particularly vulnerable to chickenpox complications.

The recommended 2 doses of the vaccine are estimated to offer 98% protection from chickenpox in children and 75% protection in adolescents and adults.

So it may be possible to develop the infection after vaccination. Similarly, there is a chance that someone who has received the vaccine could develop chickenpox after coming in close contact with a person who has shingles.

Treatment

There is no cure for chickenpox, and the virus usually clears up by itself without any treatment.

However, there are ways of easing the itch and discomfort, and there are important steps you can take to stop chickenpox spreading.

Painkillers

If your child is in pain or has a high temperature (fever), you can give them a mild painkiller, such as paracetamol (available over the counter in pharmacies). Always read the manufacturer's dosage instructions.

Paracetamol is the preferred painkiller for treating the associated symptoms of chickenpox. This is due to a very small risk of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, causing adverse skin reactions during chickenpox. 

Avoid giving your child ibuprofen if they have asthma or a history of stomach problems. If you're not sure whether ibuprofen is suitable, check with your GP or pharmacist. If your child is younger than 3 months old, you should always speak to your GP before giving your child any kind of pain relief.

Never give your child aspirin if you suspect or know that they have chickenpox.

If you're pregnant and need to take painkillers, then paracetamol is the first choice. You can use it at any stage of pregnancy. Only take ibuprofen during the second trimester (weeks 14-27 of the pregnancy).

If you're pregnant and have chickenpox, you should visit your GP as soon as possible. You may need to have antiviral medicine or immunoglobulin treatment to prevent your symptoms from getting worse.

Keeping hydrated

It is important for children (and adults) with chickenpox to drink plenty of water to avoid dehydration. Sugar-free ice lollies are a good way of getting fluids into children. They also help to soothe a sore mouth that has chickenpox spots in it. 

Avoid anything that may make the mouth sore, such as salty foods. Soup is easy to swallow as long as it is not too hot.

Stop the scratching

Chickenpox can be incredibly itchy, but it's important for children (and adults) to not scratch the spots, to avoid future scarring.

One way of stopping scratching is to keep fingernails clean and short. You can also put socks over your child's hands at night to stop them scratching the rash as they sleep.

If your child's skin is very itchy or sore, try using calamine lotion or cooling gels. These are available in pharmacies and are very safe to use. They have a soothing, cooling effect.

A stronger medicine called chlorphenamine can also help to relieve the itching. It's available from your pharmacist over the counter or it can be prescribed by your GP. Chlorphenamine is taken by mouth and is suitable for children over 1 year old.

Cool clothing

If your child has a fever, or if their skin is sore and aggravated, dress them appropriately so that they don't get too hot or too cold. Loose-fitting, smooth, cotton fabrics are best and will help stop the skin from becoming sore and irritated.

If your child has chickenpox, avoid sponging them down with cool water. This can make your child too cold and may make them shiver.

Antiviral medicine

Aciclovir is an antiviral medicine that is sometimes given to people with chickenpox.

Aciclovir may be prescribed to:

• pregnant women
• adults, if they visit their GP within 24 hours of the rash appearing
• newborn babies
• people with a weakened immune system (the body’s defence system)

Ideally, aciclovir needs to be started within 24 hours of the rash appearing. It does not cure chickenpox, but it makes the symptoms less severe. You normally need to take the medicine as tablets 5 times a day for 7 days.

If you are taking aciclovir, make sure you drink plenty of fluids. Side effects are rare, but can include nausea and diarrhoea.

To prevent spreading the infection, keep children off nursery or school until all their spots have crusted over.