Chickenpox in babies: spots, stages and when to call the doctor
Those first few spots can be alarming when you are not sure what you are looking at. If you have just noticed a cluster of small red dots on your baby and chickenpox is on your mind, this guide will walk you through what to expect, how to keep your baby as comfortable as possible, and the one medicine rule that every parent needs to know.
What chickenpox is and how it spreads
Chickenpox is caused by the varicella zoster virus. It is one of the most contagious infections a child is likely to encounter, which is why it still passes rapidly through nurseries and playgroups even when only one child brings it in.
The virus spreads in two ways: through the air when an infected person coughs or sneezes, and through direct contact with the fluid inside the blisters. This means your baby does not need to touch another child directly to catch it, simply being in the same room is often enough.
Most people catch chickenpox in childhood. It is now preventable by vaccine, which is part of the routine childhood schedule in the US and several other countries, and is available privately in the UK. Once your baby has had chickenpox, they are usually immune for life, though the virus stays dormant in the body and can reactivate later in life as shingles.
The incubation period is 10 to 21 days. That means your baby may have been exposed to the virus up to three weeks before any spots appear, which is why it can feel like chickenpox has come from nowhere.
How the rash develops
The chickenpox rash does not appear all at once. It comes in waves, or "crops", over three to five days, which is what makes it look so varied.
Here is how each crop progresses:
- Stage one: red spots. Small red or pink flat spots appear, usually starting on the face, scalp and trunk before spreading to the rest of the body.
- Stage two: blisters. The spots fill with clear fluid and become raised blisters, known as vesicles. This is when they become intensely itchy. The fluid inside is infectious.
- Stage three: scabs. The blisters burst and crust over, forming dry scabs. Once all spots have reached this stage, your baby is no longer contagious.
Because new crops keep appearing while earlier ones are drying out, you may see spots at all three stages at the same time in different parts of the body. This is completely normal with chickenpox and is one of the things that helps distinguish it from other rashes.
The spots can appear almost anywhere: the mouth, ears, eyelids and nappy area are all common sites, and spots in these places can be especially uncomfortable for your baby. If you notice spots near or in the eyes, contact your GP on the same day as this needs to be assessed.
How to keep your baby comfortable
There is no treatment that shortens chickenpox in healthy babies, but there is plenty you can do to help your baby feel more settled while it runs its course.
- Cool baths. A lukewarm bath without soap can soothe itchy skin. An oatmeal bath (using colloidal oatmeal from a pharmacy) adds extra relief. Pat your baby dry gently afterwards rather than rubbing, to avoid irritating the spots.
- Calamine lotion or Poxclin mousse. Apply to the spots with a cotton wool ball. Both are available over the counter and are safe for babies. Poxclin is a cooling mousse designed specifically for chickenpox and many parents find it easier to apply than lotion. Reapply as often as you like.
- Trim fingernails. Keep your baby's nails short to reduce the damage from scratching. Scratching can break the skin and let bacteria in, which sometimes leads to a secondary skin infection.
- Loose, cool clothing. Dress your baby in soft, loose-fitting clothing and avoid anything scratchy. Keeping them cool helps reduce the itching.
- Paracetamol for fever and discomfort. If your baby has a fever or seems particularly uncomfortable, infant paracetamol at the correct dose and interval for their age is safe and effective. Always follow the dosing instructions on the packaging.
Why you must not give ibuprofen for chickenpox
This is the most important safety point in this article: do not give ibuprofen to a baby or child with chickenpox.
Ibuprofen is an anti-inflammatory pain reliever (brand names include Nurofen for Children and Calprofen). When given to children who have chickenpox, it has been linked to a significantly increased risk of serious bacterial skin infections, including necrotising fasciitis, a severe and potentially life-threatening infection of the deep tissue beneath the skin.
This is not a theoretical precaution. It is a documented safety warning from both the NHS and the Medicines and Healthcare products Regulatory Agency (MHRA). The evidence is strong enough that ibuprofen should be avoided entirely when chickenpox is present, even if you have given it safely to your baby before for other illnesses.
Paracetamol is the right choice for managing fever and discomfort during chickenpox. It is safe and effective. You should also avoid aspirin for any baby or child under 16.
When to be more careful about who your baby is near
Chickenpox can be much more serious for some people than it is for a healthy baby. While your baby is infectious (from one to two days before the rash appears until all the spots have crusted over), try to keep them away from:
- Newborns under four weeks old. Very young babies have immature immune systems and can become seriously unwell with chickenpox.
- Pregnant women who have not had chickenpox or been vaccinated. Chickenpox during pregnancy can cause complications for both the mother and the baby.
- Anyone with a weakened immune system, including people having chemotherapy, those on high-dose steroids, and people with conditions such as HIV.
If your own baby was born prematurely, has an immune condition, or takes steroid medication regularly, speak to your GP or specialist as soon as you know there has been an exposure in your area, even before any spots appear.
Red flags: when to call a doctor or 999
Chickenpox in a healthy baby is usually a manageable illness at home. However, there are situations that need medical attention promptly.
Call 999 or go to A&E immediately if your baby:
- Is having difficulty breathing or breathing faster than usual
- Has skin that has turned blue, grey, pale or blotchy
- Is very difficult to wake or unusually drowsy
Contact your GP or call 111 on the same day if:
- There are spots near or in your baby's eyes, as these need prompt assessment
- Spots have become very red, hot, swollen or have yellow or green discharge, which can suggest a bacterial skin infection
- Your baby seems much more unwell than you would expect for chickenpox
- Your baby is under four weeks old and has chickenpox
- Your baby is immunosuppressed, was born very prematurely, or is on regular steroid medication
If you are worried at any point and are not sure which category you fall into, call 111. They will help you decide what to do next, and it is always right to ask.
Antiviral medication
An antiviral medicine called aciclovir is not routinely prescribed for chickenpox in otherwise healthy babies. It works by slowing the spread of the virus in the body, but for most healthy children the illness resolves on its own without it.
Aciclovir may be prescribed for babies who are at higher risk of complications: those who are immunosuppressed, very young, or have an underlying condition that makes severe illness more likely. If this applies to your baby, contact your GP as soon as the first spots appear, because aciclovir is most effective when started within 24 hours of the rash appearing.
The vaccine
The chickenpox vaccine (sold as Varivax or Varilrix) is part of the routine childhood immunisation schedule in the US, where it is given at 12 to 15 months and again at 4 to 6 years, and in several other countries.
In the UK it is not currently on the NHS childhood schedule, but it is available privately from many GP practices and travel clinics. The vaccine does not eliminate the risk of catching chickenpox entirely, but it significantly reduces the chance of your child getting it, and those who do catch it after vaccination almost always have a much milder illness.
If you are in the UK and interested in the vaccine, speak to your GP or a private clinic about getting it for your child.
Frequently asked questions
How long is chickenpox contagious?
Chickenpox is contagious from one to two days before the rash appears until all the spots have crusted over and dried out, which usually takes five to seven days from when the first spots appear. Your baby must stay away from nursery, childminders and public spaces during this entire period.
Can I use calamine lotion on my baby?
Yes, calamine lotion is safe to apply to chickenpox spots in babies and can help relieve itching. Poxclin mousse is another gentle option designed specifically for chickenpox. Apply with a cotton wool ball or clean fingertips and reapply as often as needed. Avoid putting it directly in or around the eyes.
Why should I not give ibuprofen with chickenpox?
Ibuprofen is an anti-inflammatory and its use during chickenpox has been linked to a significantly increased risk of serious bacterial skin infections, including necrotising fasciitis, in some children. This is a documented safety warning from the NHS and the MHRA. Use paracetamol instead for fever and discomfort during chickenpox.
How long does chickenpox last?
The spots typically appear in waves over three to five days. Most children feel unwell for five to ten days in total, and all the spots usually crust over and heal within one to two weeks. Your baby is no longer contagious once every spot has dried into a scab.
Can my baby catch chickenpox if they have been vaccinated?
The chickenpox vaccine significantly reduces the risk of catching the virus, but it does not eliminate it entirely. Vaccinated children who do catch chickenpox generally have a much milder illness with fewer spots and a quicker recovery.
When should I take my baby to hospital with chickenpox?
Call 999 or go to A&E immediately if your baby is having difficulty breathing, their skin has turned blue or grey, or they are very difficult to wake. See a doctor urgently if spots become very red, hot, swollen or weepy (signs of a skin infection), if spots appear near or in the eyes, or if your baby is under four weeks old, was born prematurely, or is immunosuppressed.
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