Chickenpox brings fever, lethargy and itchy blisters that come in waves over three to five days and then dry up. Your child is contagious from a couple of days before the rash appears until every blister has scabbed over, and can go back to förskola (municipal preschool, from age one) once the blisters have dried up and your child feels well. That takes about a week. The itching is the hard part: cool baths, cooling cream and short nails are what help.
It starts with a note on the förskola door: chickenpox in the group. Two weeks later the four-year-old wakes up with a fever and three red spots on her tummy, and by the evening there are twenty. Chickenpox is one of the illnesses almost every child gets, usually before school age, and it is rarely dangerous. But it is a week of itching, bad sleep and VAB (paid leave to care for a sick child). Here is how it progresses, what eases it and what to keep an eye on.
How it progresses
- Incubation period of two to three weeks from infection. Your child is lively and not yet contagious.
- One to two days before the rash: fever, tiredness, less appetite, sometimes a sore throat. Your child is now contagious, without anyone knowing it.
- Days one to five with the rash: small red spots that turn into fluid-filled blisters within a few hours, first on the trunk and scalp, then the face, arms and legs, often in the mouth and around the genitals too. New blisters come in waves, so your child has spots, blisters and scabs all at once.
- Days five to seven: no new blisters, the old ones dry up and scab over. The fever is gone, the itching eases.
- Week two: the scabs fall off. Small pale marks can be visible for months but usually disappear.
The itching: what helps
- A cool bath or shower several times a day, without rubbing. Pat dry with the towel.
- Cooling cream, liniment or lotion from the apotek (pharmacy) applied to the blisters. The pharmacy knows what suits your child's age.
- Short, clean nails, and cotton mittens at night for small children who scratch. Scratched blisters can get infected and leave scars.
- A cool bedroom and cool, loose cotton clothes. Heat makes the itching worse, so no fleece pyjamas this week.
- Anti-itch medicines exist for children, but ask the pharmacy or 1177 (the national healthcare helpline) first about what suits your child and follow the packaging.
- Distraction. A film, a puzzle, an audiobook. A child with something to do scratches less, and this week screen time is negotiable.
Fever medicine may be needed if your child is lethargic. Read the packaging and ask the pharmacy what is suitable. With chickenpox, healthcare staff often advise against ibuprofen, so do not give it without asking. Paracetamol-based pain relief is usually what is recommended, in the right dose for age and weight according to the packaging.
Contagion: who should you tell?
Chickenpox spreads through the air and through blister fluid, and your child is most contagious in the days before the rash appears. That means the whole förskola group has already been exposed by the time you find out, and there is not much to be done about it. What matters is telling adults who have never had chickenpox, pregnant women and people with weakened immune systems, because for them an infection can be serious. If you are pregnant and unsure whether you have had chickenpox, ring your midwife. Siblings who have not had it almost always get it, about two weeks later, so expect a second round at home.
Förskola
| Can go back | Stays home |
|---|---|
| All blisters have dried up and scabbed over | New blisters are still appearing |
| Fever-free and up to joining in | Fever or lethargic |
| The itching is manageable | Itches so much the child cannot take part |
| Scabs are visible, which is fine | Weeping, open blisters |
When to seek care
| Seek care | Wait at home |
|---|---|
| A baby under one month with chickenpox: ring the same day | A child over one with a typical course |
| Blisters that turn red, swollen, warm or get a yellow crust: infected | Blisters that dry up and turn brown |
| A high fever that comes back after going down | A mild fever in the first days |
| Drowsy, hard to wake, stiff neck, vomiting: ring 112 | Tired and whiny but responsive and drinking |
| Difficulty breathing, or a cough with breathlessness | A bit of a cough from a cold at the same time |
| Not drinking because the mouth hurts, little urine | Eating less but drinking |
| Unsteady walking, severe headache, confusion | Complaining about the itching |
Adults, pregnancy and the vaccine
Chickenpox in adults is often a considerably heavier illness than in children. A parent who has not had it and is now nursing a child with chickenpox can fall ill two weeks later, and pregnant women should always contact their maternity clinic if they have been exposed. There is a vaccine, but it is not part of the Swedish childhood vaccination programme, so it is your own choice and your own cost. BVC (the child health clinic every family is enrolled in) or a vaccination clinic can tell you more. After the illness the virus stays in the body for life, and much later it can cause shingles, which is the same virus in a different form.
How we do it with our families
Chickenpox week is a week when many families ring us. The child is too lively for the sofa but not allowed at förskola, and you have days full of meetings. Esther took three such days with a family this spring: a cool bath in the morning, cream on the blisters, puzzles instead of pillows, and on the note she wrote how many new blisters she had seen that day so the parents knew whether it had turned. She has had chickenpox herself, and that is something we always ask before sending anyone to a child with chickenpox.
This text is general information and does not replace advice from BVC (the child health clinic), your vårdcentral (local health centre) or 1177 (the national healthcare helpline). If you are worried about your child, call 1177. In an emergency, call 112.
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Read more: Hand, foot and mouth disease in children · Fever in children · A nanny when your child is sick · VAB
Frequently asked questions
How long is chickenpox contagious?
From a couple of days before the rash appears until all the blisters have dried up and scabbed over, usually five to seven days after the first ones came. So your child is contagious before you know about it, which is why chickenpox goes through a whole förskola group.
When can my child go back to förskola?
Once all the blisters have dried up and your child feels well and is up to joining in, according to the recommendation from Folkhälsomyndigheten. The scabs do not need to have fallen off. That usually means about a week at home, sometimes a little more if the blisters came in many waves. Tell the förskola the same day you see the rash.
Is there a vaccine against chickenpox?
Yes, but it is not part of the general vaccination programme in Sweden, so it is something you pay for yourselves if you want it. Talk to BVC or a vaccination clinic if you are considering it. Children who have already had chickenpox do not need it; they have protection that lasts for life.
What can we do about the itching?
A cool bath or shower, cooling cream or liniment from the pharmacy, short nails, cool cotton clothes and a cool bedroom. The pharmacy can advise on anti-itch remedies that suit your child's age. Ask before you give anything, and do not use ibuprofen for chickenpox without having spoken to healthcare staff.
Can you get chickenpox twice?
Very rarely. After chickenpox the virus stays in the body and can cause shingles much later, which is the same virus in a different form. Adults who have never had chickenpox can become seriously ill from a child with chickenpox, so tell grandparents who are unsure.