Herpes in Children: Symptoms, Treatment, Transmission and Returning to Group Care

Herpes Is Not Just One Thing: Which Types Affect Children

We often use the word herpes to describe a small blister on the lip, but it refers to a broader group of viral infections. In children, it is particularly useful to distinguish between herpes simplex virus and varicella-zoster virus.

Herpes simplex virus type 1 (HSV-1) is a common cause of cold sores on the lips and around the mouth. However, a child’s first contact with the virus may involve more than a single blister. They may have painful sores or blisters in the mouth, sensitive gums, refuse food and drinks, feel tired or have a raised temperature. Later, the virus may reactivate repeatedly and appear as a typical cold sore, for example during fatigue, stress, sun exposure or another illness.

Varicella-zoster virus causes chickenpox. After chickenpox, it can remain in the body and later reactivate as shingles, also known as herpes zoster. This is why shingles is linked to having had chickenpox. The claim that anyone with herpes must have previously had chickenpox is therefore a myth.

If you are unsure whether it is a cold sore, canker sores, impetigo or another skin or mucous membrane problem, contact your pediatrician. Especially with a first outbreak, significant pain or a young child, it is not worth guessing.

How Herpes Simplex Spreads and Why to Be Careful Around the Eyes

Herpes simplex is transmitted mainly through direct contact with saliva or fluid from a blister. A child can become infected through kissing or sharing a glass, cutlery, bottle, pacifier, towel or lip balm. The virus can also spread via hands if someone touches a cold sore and then touches objects or another person.

A cold sore does not necessarily stay on the lip. A child may scratch or touch the area and transfer the virus with their hands to another part of the body. Pay particular attention to the eyes: teach your child not to touch the cold sore and then rub their eyes. If the eye is red, painful or watery, or if there is light sensitivity, eyelid swelling or a change in vision, contact a doctor without delay.

Infectiousness is usually highest when active blisters, oozing or scabs that have not yet dried are present. However, the virus can spread even without an obvious cold sore, so regular hand hygiene and not sharing items that come into contact with the mouth are worthwhile.

• Wash hands with soap and water, especially after caring for the area around the mouth.
• Do not pop blisters or pick at scabs.
• Give your child their own glass, cutlery, towel and toothbrush.
• Do not share pacifiers, teething toys or bottles between siblings.
• Avoid covering the cold sore with irritating products unless recommended by a doctor or pharmacist.

What Can Relieve Your Child’s Discomfort and When to Call the Pediatrician

With an ordinary cold sore, the main goals are relief, enough fluids and gentle care. Offer your child small sips regularly. If their mouth hurts, they often tolerate cooler, soft and non-irritating foods better. Sour, salty, spicy or very hot foods may sting.

Always discuss treatment, including any antiviral medicines, with your pediatrician. Not every cold sore requires the same approach, and young children should not use medicines or creams intended for adults without professional advice. The pediatrician will assess the extent of the symptoms, the child’s age and overall condition, as well as whether further examination is needed.

Vitamins are not a quick treatment for herpes. There is no vitamin supplement that can reliably be promised to speed up cold-sore healing. Adequate B vitamins are important. A varied diet, an appropriate intake of protein, fruit, vegetables and fluids are also important for immunity and recovery. Give supplements containing vitamins D or C, zinc or other substances only in an age-appropriate dose and after consulting your pediatrician or pharmacist, especially if your child takes other products. 

Contact your pediatrician if your child has a high or persistent temperature, severe pain, extensive sores in the mouth, refuses or is unable to drink, urinates less than usual, is unusually lethargic, has symptoms around the eye, a rapidly worsening rash or a weakened immune system.

Why a Child with Active Herpes Should Stay Out of Group Care

Sending a child with an active cold sore to daycare or preschool can be a difficult decision, especially if they otherwise feel well. It is important, however, to consider how easily it can spread through shared play, touch, saliva and toys, as well as how often young children touch their faces and mouths. In a group setting, it is also difficult to ensure that a child will not touch the blister and will wash their hands thoroughly after every contact.

A sensible general rule is to return only when the lesions are dry and crusted, the child has no fever, feels well and can follow basic hygiene rules. Specific requirements may vary by facility and according to the symptoms, so also follow the daycare or preschool’s instructions and your pediatrician’s advice. After a first outbreak with mouth sores or general symptoms, the child usually needs rest and home care even more.

If your child has shingles, consult your pediatrician about what to do. The blisters should be covered with clothing or a clean dressing as recommended by the doctor, and contact should be avoided especially with people who have not had chickenpox or are at increased risk of complications.

A Newborn in the Family: Protecting Them Carefully, Without Panic

With herpes simplex, it is especially important to protect a newborn. Their immune system is immature, and the infection can be severe in newborns and, in some cases, life-threatening. For this reason, anyone with a cold sore should not kiss the newborn, touch their face or hands, or share any items that come into contact with the baby’s mouth.

If a parent, sibling or visitor has a cold sore, the safest approach is to keep away from the baby’s face, wash hands thoroughly and cover the cold sore if possible. It is completely fine to postpone a visit. If a breastfeeding mother has a cold sore on her lip, discuss questions about contact with the baby and breastfeeding with a pediatrician or doctor; professional advice is especially important if there are lesions on the breast.

Do not wait if a newborn has a fever, is unusually sleepy or irritable, feeds poorly, develops blisters or shows other worrying symptoms. Contact the pediatrician or emergency medical service immediately. Caution is not overreacting – it is a caring way to protect your baby.