You’ve probably heard about shingles—maybe you’ve even experienced the painful rash yourself—but what exactly is the relationship between shingles and chicken pox, and can kids get it? Here’s what you need to know about shingles in children.
Shingles is a viral infection, caused by the varicella-zoster virus, which is the same virus responsible for chicken pox. After you’ve had the chicken pox, the virus becomes inactive in your body, but hides out in your nerve tissue. For some people, the inactive virus reactivates later in life, causing a red rash with small blisters filled with fluid. About 30 percent of people who have had chicken pox go on to have shingles sometime in their life, usually after the age of 60, but it can happen at any age. Sometimes this happens because the body is under stress but other times it happens for no apparent reason.
The risk of shingles increases with age—in Canada, more than two-thirds of all cases are in people over the age of 50, according to Health Canada. So while a case of shingles is possible, it’s not common in kids with healthy immune systems.
Kids who have had the chicken pox vaccine are less likely in general to get shingles at any point in their lives. For one thing, the vaccine works well but is not 100 percent effective, and occasionally a vaccinated kid can come down with the chicken pox, although it is usually a milder case. It’s possible for a child who has had the chicken pox vaccine to come down with shingles later in life, because they were exposed to the virus in much-weakened form in the vaccine. “Children who get the vaccine are less likely to get shingles than children who have regular chicken pox,” saysSean O’Leary, a paediatrician and paediatric infectious disease specialist in Denver.
If your child gets the chicken pox before the age of one, or you had the chicken pox very late in your pregnancy, your child has a slightly higher risk of shingles, generally later in life as opposed to childhood. “The in utero exposure is essentially the infant’s case of chicken pox,” says O’Leary, meaning that child could get shingles at some point, but wouldn’t need to have an active case of chicken pox first.
It’s more common for kids with immune systems that aren’t working well—for example a child who is going through chemotherapy or a child with rheumatoid arthritis taking medications that suppress the immune system—to develop shingles, says O’Leary.
You don’t develop shingles without first having the chicken pox virus in your body, so it’s unlikely that a baby would get shingles. If a woman has had the chicken pox (or the chicken pox vaccine) any time in her life, she passes along some immunity to the chicken pox to her baby while she’s pregnant, and this partial immunity lasts until the baby is six to 12 months of age, says O'Leary. (However, the immunity isn’t necessarily complete and it is possible for an unvaccinated infant to get the chicken pox.) In Canada, the chicken pox vaccine is part of routine vaccinations, with the first shot at 12 to 15 months (depending on your province or territory) with a second follow-up shot sometime before the age of six (again depending on where you live).
Postpartum women can sometimes come down with shingles, because the dormant virus can kick in when the body is under stress. “One of the common questions that comes up is, what about a mom who is breastfeeding and she has shingles? Can she breastfeed? And the answer is, is in most cases, yes,” says O’Leary. “If there are shingles actually on the breast, the recommendation is that if it can be covered, then it’s OK to breastfeed. But if it’s near the nipple, where the baby would be nursing, then it's recommended that they pump from that breast and discard the milk, until the lesions are crusted over. If a mom does have shingles, anywhere else [on], she just keeps it covered [and].”
Similarly, if you or another adult, such as a grandparent, who has shingles is caring for an unvaccinated child, he says covering the sores with a bandage and washing hands thoroughly should be enough to avoid transmission. (However, to really be on the safe side an older adult with shingles may want to take time off from looking after an infant.)
Before the shingles sores emerge, there can be a burning, itching, tingling sensation in the skin, with the rash appearing up to five days later. “Shingles show up as painful blistery lesions, and they then fill with fluid, and then they scab over,” says Michelle Ponti, a paediatrician in London, Ontario. She says these kind of red, rashy lesions, which look similar to chicken pox, are found in a strip or patch on only one side of the body—the left side of the torso, for example, rather than all over the torso. There may also be a fever, headache or chills.
Fortunately, shingles pain tends to be milder for kids than it is in adults. “The little spots themselves aren’t that painful,” says O’Leary, explaining that for adults, who can often experience intense pain from shingles, the pain comes from the virus affecting nerves in the body, not from the actual sores on the skin. However, for kids the sores may be itchy, he says. They scab over after a few days and should heal completely in two to four weeks.
Shingles is contagious, but not nearly as contagious as chicken pox. “Chicken pox is very, very contagious because it spreads through coughing and spreads through the air very easily,” says O’Leary. “Shingles, on the other hand, is spread almost exclusively by direct contact with the sores themselves.” If you have skin contact with the fluid in a shingles sore, you’ve been exposed to the varicella-zoster virus, and could come down with the chicken pox. (In other words, exposure to the virus from shingles leads to chicken pox, not directly to shingles.) The shingles sores are contagious until they are scabbed over.
Usually a doctor makes the diagnosis based on the symptoms (particularly the symptom of the rash appearing on just one half of the body) but a blood test or lab test of a small sample of a sore may be used to confirm the diagnosis.
Shingles treatment is mainly about treating the symptoms, says Ponti, such as age-appropriate over-the-counter pain medication for pain. Depending on the situation, your doctor may also prescribe anti-viral medication, she says, adding that if your kiddo is scratching the sores and gets a bacterial infection on top of the viral infection, they may need antibiotics. She cautions that shingles near the eyes can be very serious, potentially permanently damaging the eye, so that situation needs to be monitored closely by a doctor.
O’Leary says that a non-steroid, over-the-counter product like calamine lotion can help soothe the skin if the sores are itchy. “In most cases, if the sores can be covered, it’s not considered contagious,” he says. “We recommend covering the sores with a dry, clean bandage.” Avoid contact with someone who has never had the chicken pox, especially babies and young children, pregnant women and the elderly.
Shingles vaccines are available and in Canada are recommended for adults age 50 and up, but they are not recommended for children.
Bottom line: kids get all kinds of rashes. It’s unlikely that your child’s rash will turn out to be shingles, but if a rash shows up on just one half of the body, it’s worth getting checked out.
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