Shingles (Herpes Zoster) in Children

What is shingles in children?

Shingles (herpes zoster) is a painful skin rash. It’s caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox.

What causes shingles in a child?

After a person has chickenpox, the virus stays in the body’s nerve cells but is inactive. Months or years later, the varicella-zoster virus can become active again. The virus can then cause a red rash or small blisters, usually on one side of the body. The rash or blisters spread along a nerve pathway where the virus was living.

Which children are at risk for shingles?

Shingles in children is not common. A child is more at risk for shingles if any of these are true:

• They had chickenpox before age 1.
• The child’s mother had chickenpox very late in pregnancy.
• The child has a weak immune system from a health condition or certain treatments, such as cancer therapy.

Children who get the chickenpox vaccine still have a small risk for shingles. But it may be a lower risk than after a chickenpox infection. And the symptoms may be less severe.

What are the symptoms of shingles in a child?

The symptoms start with pain, burning, tingling, or itching on one part of the face or body. The rash can appear up to 5 days after these symptoms.

The shingles rash most often occurs on the torso and buttocks. It may also appear on the arms, legs, or face. The rash starts as small, red spots that turn into blisters. The blisters turn yellow and dry. The rash is usually only on one side or part of the body. It goes away in 2 to 4 weeks.

Your child may also have symptoms, such as:

• Fever and chills
• Headache
• Nausea 

The symptoms of shingles can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is shingles diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. Your child will have a physical exam. Shingles can generally be diagnosed by the exam alone. Your child may also have tests, such as:

• Skin scrapings. The blisters are gently scraped to remove tiny samples. The samples are tested to check for the virus.

How is shingles treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment right away with antiviral medicine may help lessen how long the symptoms last and how serious they are. These antiviral medicines work better the sooner they are started. Your child may be given acyclovir, famciclovir, or valacyclovir. Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

Ask the healthcare provider about over-the-counter pain medicine. You may be able to give acetaminophen or ibuprofen for fever and discomfort. Don't give ibuprofen to a child younger than 6 months old, unless your healthcare provider tells you to. Don't give aspirin to children. Aspirin can cause a serious health condition called Reye syndrome.

If your child’s pain is severe, the healthcare provider may prescribe stronger pain medicine.

What are possible complications of shingles in a child?

A shingles rash can get infected with bacteria, causing a skin infection (cellulitis). After the shingles rash is gone, the pain may continue for a long time. This is a complication called postherpetic neuralgia. Talk with the healthcare provider if your child’s pain stays after the rash goes away.

How can I help prevent shingles in my child?

There is a shingles vaccine for adults. It's not given to children younger than 19 except in certain cases. This is because shingles is more severe in adults who are older or immunocompromised.

A child who has had the chickenpox vaccine may have milder symptoms of shingles. If your child has not had chickenpox, talk with the healthcare provider about the chickenpox vaccine.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms

Key points about shingles in children

• Shingles (herpes zoster) is a painful skin rash. It’s caused by the virus that causes chickenpox.
• Shingles in children is not common.
• The symptoms start with pain, burning, tingling, or itching on one part of the face or body. The virus can then cause a red rash or small blisters, usually on one side of the body.
• Treatment right away with antiviral medicine may help lessen how long the symptoms last and how serious they are.
• If your child’s pain is severe, the healthcare provider may prescribe strong pain medicine.
• There is a shingles vaccine for adults. It is rarely used for children younger than 19. A child who has had the chickenpox vaccine may have milder symptoms of shingles. 

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.