Cold sores, also known as fever blisters, are a common concern for parents, and toddlers are indeed susceptible to them. These small, fluid-filled blisters are primarily caused by the herpes simplex virus type 1 (HSV-1). While cold sores are generally harmless in older children and adults, a toddler’s initial infection can sometimes be more severe.
Identifying Cold Sores on Toddlers
Cold sores often begin with a tingling, itching, or burning sensation around the mouth, though toddlers might not clearly express these initial feelings. Soon after, small, red blisters typically appear on or near the lips, but they can also form on the chin, cheeks, or nose. During an initial infection, particularly in toddlers, these blisters may spread beyond the lips to involve the gums and inside the mouth, a condition known as herpetic gingivostomatitis.
These blisters eventually rupture, ooze fluid, and then crust over, forming a scab. The entire process, from blister formation to healing, usually takes about 10 to 14 days.
Other symptoms accompanying a toddler’s first cold sore outbreak can include:
Fever
Swollen and tender lymph glands
Irritability
Drooling
A reluctance to eat or drink due to mouth pain
How Toddlers Contract Cold Sores
The herpes simplex virus type 1 (HSV-1) is highly contagious and spreads through direct contact. Most children are first exposed to HSV-1 between the ages of one and five years. Toddlers often contract the virus from adults or other children with active cold sores, through close contact like kissing, or by sharing contaminated items.
The virus can transmit through sharing eating utensils, cups, towels, or even toys. The virus can be present in saliva even when no visible cold sore is present. Once a toddler is infected with HSV-1, the virus remains in their body for life, residing in nerve cells, and can reactivate later to cause future outbreaks.
Caring for a Toddler with Cold Sores
Managing a toddler’s cold sore involves easing discomfort and preventing further spread. Applying a cold compress or ice to the affected area can help reduce pain and swelling. Offering cool, non-acidic foods and drinks, such as smoothies or ice pops, can be soothing and help prevent dehydration, especially if mouth pain makes eating difficult.
For pain relief, parents can consult their pediatrician about giving acetaminophen or ibuprofen in appropriate dosages. It is important not to give aspirin to children under 18 due to the risk of Reye’s syndrome. Cold sores often heal on their own. However, a doctor might prescribe antiviral medications, such as acyclovir, to shorten the outbreak duration, especially for severe cases or frequent recurrences.
Preventing Spread and Future Outbreaks
Preventing HSV-1 spread requires diligent hygiene practices. Caregivers and the toddler should wash hands frequently, particularly after touching the cold sore. Avoid sharing personal items like cups, utensils, towels, and toothbrushes while a cold sore is active. Discarding the toothbrush used during an outbreak is also recommended.
To minimize future cold sore outbreaks, parents can identify and mitigate potential triggers. Common triggers include stress, fever, other illnesses, sun exposure, and dry weather. Applying lip balm with sunscreen can help protect against sun-induced outbreaks.
When Cold Sores Are More Serious
While most cold sores in toddlers are not serious, certain signs warrant prompt medical attention. If the sores spread to the eyes, causing redness or pain, this could indicate ocular herpes, a serious condition that can affect vision. Widespread sores on the body, especially in toddlers with chronic skin conditions like eczema, can lead to a more severe infection called eczema herpeticum.
Signs of dehydration, such as reduced urination, dry mouth, or lethargy, require immediate medical evaluation, as a toddler’s mouth pain can make drinking difficult. A high fever, confusion, or seizures during an outbreak could signal a rare but serious brain infection. If the cold sores do not begin to heal within 7 to 10 days, or if the child is under six months of age, medical consultation is recommended.