The young mother picked up her toddler from daycare and noticed a blister developing near her daughter’s lower lip. She figured it was a cold sore and wondered what to do. Sarah Nickerson, MD, Pediatrician at McLane Children’s Scott & White Clinic […]
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Caring for Cold Sores

by Baylor Scott & White Staff on March 29, 2013

in Medical Information

coldsoreThe young mother picked up her toddler from daycare and noticed a blister developing near her daughter’s lower lip. She figured it was a cold sore and wondered what to do.

Sarah Nickerson, MD, Pediatrician at McLane Children’s Scott & White Clinic – Killeen Hemingway, says that though cold sores are a common part of childhood, they still need to be treated by a physician — at least for the first infection.

What Are Cold Sores?

Cold sores — sometimes called fever blisters — are infections caused by the herpes simplex virus.

“Initially, they look like little blisters. The blisters will often pop and scab over. It’s common that they’ll happen around the mouth and then on the face, if they progress that far,” Dr. Nickerson says.

Cold sores may appear as a single blister on the lip area, or, in severe cases, there can be dozens of blisters spread across the mouth area and face.

Cold sores generally last for a week up to several weeks.

Once your child gets a cold sore, the herpes simplex virus remains dormant within the nerve root. The virus can be reactivated in that nerve root months or years later.

Who Gets Cold Sores?

Cold sores can strike anyone, even young babies, Dr. Nickerson says. The first infection usually happens at any time from birth to age 5, with most cases happening in the toddler years.

What Is the Treatment for Cold Sores?

Treatment generally depends on how bad a case of cold sores your child has.

“Children who can’t control secretions very well — putting their hands in their mouths, drooling on toys or pacifiers — can spread their cold sores easily to other children.”

Dr. Nickerson recommends that you take your child in to the doctor on the first sign of cold sore infection.

If your child has a mild case of cold sores, your physician will likely recommend an oral pain reliever, such as Tylenol or ibuprofen.

However, if the cold sores are severe or “if your child has problems eating or drinking because of the pain, your doctor may prescribe an antiviral medication called acyclovir, which will decrease the length of time the virus is active in your child’s system,” says Dr. Nickerson

To be effective, acyclovir should be started within the first three or four days of infection.

Herpetic whitlow.  In rare cases, some babies and toddlers, particularly thumb suckers or children with existing cases of eczema, develop very severe cases of cold sores called herpetic whitlow.

Extremely painful blisters appear on hands, fingers, torso, mouth, nose and around the eyes. Often children with herpetic whitlow will require hospitalization.

Can You Get Cold Sores Again?

Yes, because the herpes simplex virus stays in your body forever and can be reactivated, Dr. Nickerson says.

“When the herpes simplex virus is reactivated by a trigger, the virus can come up to the surface and start a new cold sore. Stress is the main trigger. This can be a lifelong problem,” Dr. Nickerson says.

If your child has had cold sores in the past, there may be some warning signs that a new cold sore may reoccur in the same spot:

  • Tingling feeling
  • Discomfort

“Many people can tell they have a cold sore coming on before they have a blister or change in their skin,” notes Dr. Nickerson.

If your child mentions tingling or discomfort in the cold sore site, have your child see his or her doctor so your child can receive acyclovir to help shorten the duration of infection.

Can Cold Sores Be Prevented?

Cold sores are contagious. You can get them from your child, and your child can get them from you and others. The virus passes easily through saliva.

The best prevention is to avoid any sort of exchange of saliva:

  • Don’t kiss your child.
  • Don’t let your child share cups, bottles or utensils.
  • Don’t let your child share pacifiers or anything else that goes in the mouth.

“You want to avoid direct contact with the lesions, like kissing,” says Dr. Nickerson, “but also avoid contact with your child’s secretions, such as touching your child’s drool, because infection spreads quickly during the drooling stage.”

If your infant or toddler has a cold sore, Dr. Nickerson suggests that you keep your child home from daycare or preschool.

“Children who can’t control secretions very well — putting their hands in their mouths, drooling on toys or pacifiers — can spread their cold sores easily to other children. Please keep them home until they’re healed,” advises Dr. Nickerson.

As a parent, you’ll also want your healthy child to avoid direct contact with anyone who has an active cold sore, Dr. Nickerson advises. Don’t allow anyone to kiss your child or drink from your child’s cup, for example, if he or she has a fever blister.

Note to Teens & Adults

If you have a cold sore on the mouth caused by herpes simplex I and have oral sex, you can transmit the virus to your partner’s genital area. Similarly, if you have herpes simplex II on your genital area and have oral sex, that lesion can be transferred to your partner’s mouth. In either case, the treatment (acyclovir) is the same.

“If you have an active cold sore, in addition to avoiding kissing, avoiding direct contact includes avoiding oral sex,” notes Dr. Nickerson.

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