Cold Sores

Also called fever blisters, cold sores are small blisters most commonly found around the lips or nose. They are symptoms of a viral infection known as oral herpes. The initial infection with herpes, primary herpes, is more severe than subsequent episodes, although in young children the first attack may be mild enough to pass unnoticed. Oral herpes is very contagious but poses no serious health threat. Most herpes sores clear up shortly with no specific treatment.

WHAT CAUSES COLD SORES?
The virus responsible for oral herpes in children is almost always herpes simplex type I, a very common virus in children and one that will affect most people at some time in their lives. It is transmitted by contact with another person's active infection, either directly by kissing or indirectly by sharing eating utensils or toys that come in contact with the mouth. It cannot be transmitted through the air or from a person whose infection is dormant.

WHEN SHOULD I SUSPECT MY CHILD HAS ORAL HERPES?
If a child has recurrent cold sores, it is likely that he or she has oral herpes resulting from a previous—possibly unnoticed—primary infection with herpes simplex I. In some children, however, the primary herpes infection is more severe. Painful sores may develop around the lips and inside the mouth on the palate, interior cheeks, and gums, making it difficult for the child to eat or swallow. In some cases, a fever and flulike symptoms develop. After a day or so, the blisters break, but the accompanying mouth ulcers may take several days to heal. Complete recovery from the accompanying symptoms of an initial attack can take two or three weeks.

After the symptoms of the primary outbreak have subsided, the virus retreats to nerves in the infected area and becomes dormant. In some children, the virus is reactivated from time to time by a stimulus such as illness, stress or sunburn, causing a cluster of cold sores to appear on or around the lips or nose. These blisters cause little or no discomfort in young children. In a few days, they grow larger, burst, crust over and disappear completely.

IS MEDICAL ATTENTION NECESSARY?
It is a good idea to have your doctor confirm the diagnosis. This can be done easily with physical examination.

WHAT TREATMENTS ARE AVAILABLE?
There is no cure for oral herpes. The cold sores will usually heal quickly on their own without specific treatment. If the child's primary infection is severe, the doctor may prescribe a medicated mouthwash to numb the pain and acetaminophen to relieve discomfort and treat the flulike symptoms. Cool compresses or ice can help alleviate pain. Over-the-counter preparations for cold sores should be used only on the advice of your doctor. Steroid-containing ointments can cause the infection to spread and should not be used. Finally, if the child's cold sores are persistent or frequent, your doctor may prescribe a medication called acyclovir, which works by inhibiting the virus's ability to duplicate.

GETTING HELP
Call your doctor if your child:

• Has frequently recurring or severe cold sores

• Complains of eye pain or impaired vision or you see a white patch on the eye. Corneal ulcers caused by herpes simplex infection can be serious if not treated.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.