Shingles in Children

Shingles is an uncommon condition in children, but they can still develop it. Chickenpox and shingles are two different infections that happen because of the varicella-zoster virus. Shingles can only happen after you have chickenpox or get the chickenpox vaccine.

While the same virus causes chickenpox and shingles, the diseases have big differences. The biggest difference is that shingles doesn’t happen right away once the varicella virus enters your body. It’s a delayed infection that only happens once the virus reactivates. It has different symptoms and effects partly because of how your immune system responds to this virus, which it already dealt with once before.

What do childhood shingles look like?

The symptoms of shingles in children are similar to the symptoms that affect adults. The symptoms include:

• Red, bumpy rash that turns into blisters
• Fever and chills
• Headache
• Malaise
• Upset stomach
• Itching or tingling on or around the rash
• Nerve pain in or near the rash

Unlike chickenpox, shingles doesn’t cause symptoms all over your body. Instead, the effects are usually on one side only. And their effects typically stay within the borders of dermatomes. Those are areas of skin that connect to a specific spinal nerve.

While the same shingles symptoms are possible for both children and adults, there are key differences. Itching and tingling around the rash are more common in children. Nerve pain in or near the rash is more common in adults. Fever and chills are also more common in adults.

Why would a child get shingles?

Shingles happens when the inactive varicella-zoster virus in your body reactivates. For that to happen, the virus has to enter your body first.

There are two ways the virus can enter your body:

• If you catch the virus from someone else (this includes transmission to a fetus during pregnancy) and get chickenpox
• From the varicella-zoster virus vaccine

When you have chickenpox or get the varicella vaccine, your body can’t completely get rid of the virus from your body. The virus goes into hiding in your nervous system and fools your immune system into leaving it alone. It will hide as long as your immune system works as it should. But if your immune system weakens for some reason, the virus reactivates. That’s how you develop shingles.

Risk factors

There are a few main risk factors for children developing shingles. These include having:

• Chickenpox or the varicella vaccine very early in life (usually before turning 1 year old)
• A weakened immune system, like from an immune disease, or treatment for autoimmune diseases or cancer
• A history of asthma, especially if you’ve been on steroids to treat it
• Stress can make the varicella virus reactivate and cause shingles

While children with a weakened immune system have a much higher risk of developing shingles, healthy children can still develop it from the varicella vaccine. But research shows that shingles after varicella vaccination is much milder and happens less often than shingles after chickenpox.

How to lower your risk

You can lower your child’s risk of developing shingles by:

• Getting them vaccinated as recommended by their pediatrician
• Avoiding anyone who has chickenpox or shingles
• Not sharing personal items like towels if someone in your household has shingles
• Keeping the rash covered and limiting contact between yourself and your child as much as you can (if you have shingles)

Complications of this condition

Children can have the same shingles complications that adults can have. But they’re much less common in children who have shingles. These include:

• Bacterial infection
• Brain inflammation (encephalitis)
• Long-term nerve pain (postherpetic neuralgia)
• Pneumonia
• Ramsay Hunt syndrome
• Sensory loss (like vision loss or hearing loss) if shingles affects your head or face
• Hearing and balance issues (sometimes long-term or permanent), like tinnitus or vertigo

Complications from shingles — like infections, encephalitis and pneumonia — can be serious or even deadly. That’s why preventing it is so important.

How doctors diagnose shingles in children

Healthcare providers diagnose shingles in children the same way they diagnose it in adults. Providers usually suspect shingles based on the symptoms. That’s especially true when symptoms happen on only one side of your child’s body or only within specific dermatomes. They’ll also ask questions about whether your child had chickenpox or got the varicella vaccine in the past.

Your provider may also run lab tests. These include:

• Swab tests on fluid from blisters in the rash
• Taking skin scrapings and looking at them under a microscope

How is shingles in children treated?

In many cases, shingles in healthy children is mild, and no specific treatment is needed. But if it is, antiviral medications, like acyclovir (Zovirax®) or valacyclovir (Valtrex®), can help speed up recovery of the skin lesions and decrease complications. Over-the-counter pain medications like acetaminophen or ibuprofen can also treat it. Your child’s provider can tell you more about the treatments that are most likely to help your child’s case.

When should my child see their healthcare provider?

It’s important to call your child’s provider if your child has symptoms of shingles. This is especially true if your child has a weakened immune system or other risk factor diseases, like asthma. Antiviral treatments for shingles need to start early in the illness. That’s why it’s best to call your child’s provider sooner rather than later.

How serious are shingles in a child?

Shingles in healthy children usually isn’t severe, and the outlook is good overall. For the most part, children with shingles will recover within a few days to weeks. Early diagnosis and treatment can also help speed up your child’s recovery. Children are also less likely than adults to have serious complications, like long-term nerve pain.

One exception is when children have shingles on their heads or faces, like with Ramsay Hunt syndrome. This can be very severe. Early diagnosis and treatment are important because they can prevent blindness, hearing loss or other forms of permanent damage. Another exception is children with weakened immune systems, who can have severe shingles and complications from it.

Can shingles in children be prevented?

Yes, shingles in children is mostly preventable. Vaccination against the varicella-zoster virus can keep your child from developing either chickenpox or shingles. And while there are cases where vaccinated children still developed shingles, research shows those cases are almost never as severe.