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Cold Sores in Children

By M. Kelly McCarthy, M.D.

​Cold sores are painful, puss-filled blisters that primarily form in or around the mouth and the nose and are caused by a common infection that is often contracted during the preschool years.

The Cause of Cold Sores

Cold sores are caused by the Herpes Simplex Virus type 1 (HSV-1), which is a different form of herpes than the sexually transmitted disease.

HSV-1 is contagious for six to eight days and can be passed from an infected individual to an uninfected individual either through direct contact with the sore or saliva. Children often come into contact with the virus by sharing utensils or cups, and adolescents may spread the virus through kissing or direct contact in sports.

Cold Sores Caused by Secondary Infections

Even after a child has stopped showing symptoms of the initial HSV-1 infection, the virus itself stays in the nervous system – usually in an inactive state. Certain stressors may cause flare-ups of the virus and may include:

  • Emotional stress
  • Infection
  • Sunlight
  • Cold weather
  • Fever
  • Menstrual period

When a child experiences a flare-up, he/she may feel numbness or tingling at the site of the sore before the sore surfaces.

Treatment for Cold Sores

Cold sores often do not require extensive treatment, but parents are encouraged to help manage the child's pain.

  • Ease discomfort by giving your child food or drink at a cold temperature. It is best to avoid acidic drinks like orange juice or lemonade.
  • Acetaminophen may help manage pain as well. (Never give your child Aspirin, as this medication has been linked to Reyes syndrome complications.)

A pediatrician may provide an antiviral treatment to shorten the length of the HSV-1 outbreak and decrease pain. However, as mentioned previously, the virus will remain dormant in the child's nervous system.

Over-the-counter topical cream treatments may be effective for minimizing the symptoms of a cold sore outbreak, but they must be applied at the first sign of a cold sore.

When to Call Your Pediatrician about Cold Sores

In most cases, an HSV-1 infection or flare-up will not cause a serious medical condition, however parents are encouraged to set up an appointment with their child's pediatrician during the first outbreak.

Call the doctor during a cold sore outbreak (initial or secondary) if:

  • Your child has a weakened immune system, as this may allow this infection to spread to other parts of the body.
  • The sores are near the eyes.
  • The sores do not heal on their own in seven to 10 days.
  • Your child is experiencing confusion, fever or headache or has a seizure.

Parents also are encouraged to contact a doctor if their child has frequent cold sores.

Cold Sore Prevention

Though HSV-1 is very common, you can take steps to prevent your children from spreading or contracting the virus.

  • If you know an individual is infected, do not allow him/her to share cups, utensils, washcloths or towels with others.
  • Make sure your children know not to kiss anyone while they are infected.
  • Ensure infected children wash their hands after touching their sores.

It is important for parents to follow these same prevention guidelines and wash their hands frequently while caring for a child who has cold sores.