Red flags & when to go in person for Cold Sores (Herpes Labialis)

Audience: pediatric

Cold sores, also called herpes labialis, are common small blisters that appear on or around the lips. They are caused by the herpes simplex virus and often start with tingling or itching before blisters form. In children, cold sores usually heal on their own within 1 to 2 weeks without serious problems. However, some signs mean you should see a healthcare provider in person quickly. These include severe pain, spreading sores, fever, or if your child has a weakened immune system. Telemedicine can help you understand cold sores, manage mild symptoms, and know when to get in-person care. This guide explains important warning signs, what telemedicine can and cannot do, and how to prepare for a virtual visit about cold sores in children.

Red flags — go in person / ER

• Sores spreading beyond the lips or not healing after 14 days — seek in-person care promptly.
• High fever above 38.5°C (101.3°F) lasting more than 2 days with cold sores — get urgent medical evaluation.
• Eye pain, redness, or vision changes with cold sores — seek emergency in-person care immediately.

What telemedicine can do

• Assess typical cold sore symptoms via video or photo.
• Provide advice on symptom relief and care at home.
• Help decide if in-person care is needed based on symptoms.
• Answer questions about cold sore outbreaks and prevention.

What telemedicine cannot do

• Perform laboratory tests or swabs to confirm herpes infection.
• Treat severe complications like eye involvement or widespread infection.
• Provide emergency care for high fever or severe pain.
• Examine areas requiring specialized equipment or hands-on assessment.

What Are Cold Sores?

Cold sores are small, fluid-filled blisters that usually appear on the lips or around the mouth. They are caused by the herpes simplex virus (usually HSV-1). Cold sores often start with a tingling, itching, or burning feeling before blisters appear. In children, cold sores are common and usually heal on their own within 7 to 14 days.

Common Symptoms of Cold Sores in Children

Symptoms may include:

Sometimes children may also have mild fever, swollen glands, or sore throat during the first outbreak.

When to Seek In-Person Care: Red Flags

Most cold sores improve without medical treatment. However, see a healthcare provider in person if your child has:

These signs may require urgent or specialized care.

How Telemedicine Can Help

Telemedicine visits can:

A video call can allow the provider to see the sores and discuss symptoms in real time.

What Telemedicine Cannot Do for Cold Sores

Telemedicine cannot:

If your child shows red flags, an in-person visit is necessary.

Preparing for a Telemedicine Visit

Before your telemedicine appointment:

Aftercare and Monitoring

After the telemedicine visit:

Good hygiene helps prevent spread to others.

How to prepare for your tele-visit

• Ensure a stable internet connection and a device with a working camera.
• Find a well-lit area to show the cold sores clearly.
• Write down your child's symptoms, including when they started and any changes.
• List any medications, allergies, or health conditions your child has.
• Prepare to describe your child's overall health and any other symptoms.
• Have a thermometer ready if you need to report a fever.

After your tele-visit

• Follow the healthcare provider's advice on managing symptoms at home.
• Use any recommended topical treatments or pain relief as directed.
• Keep the affected area clean and avoid touching or picking sores.
• Monitor your child for any worsening symptoms or new red flags.
• Schedule an in-person visit if symptoms do not improve or red flags appear.
• Practice good hygiene to prevent spreading the virus to others.

FAQs

Can cold sores be treated with medicine?

Yes, antiviral creams or oral medications may help speed healing and reduce pain if started early. However, many cold sores heal on their own without treatment.

Are cold sores contagious?

Yes, cold sores are caused by a virus that spreads through close contact like kissing or sharing items. Avoid direct contact with sores to prevent spreading.

How long do cold sores usually last in children?

Cold sores typically heal within 7 to 14 days. The blisters break, crust over, and then clear up without scarring.

Can telemedicine diagnose cold sores?

Telemedicine can often identify typical cold sores based on symptoms and visual examination via video or photos. However, it cannot perform lab tests.

When should I take my child to the emergency room for cold sores?

If your child has eye pain or vision changes, severe pain, high fever lasting more than 2 days, or signs of spreading infection, seek emergency in-person care immediately.

Sources

1. Cold Sores — MedlinePlus, U.S. National Library of Medicine.
2. Herpes Simplex Virus Infections — Centers for Disease Control and Prevention (CDC).
3. Cold Sores (Herpes Simplex) — Mayo Clinic.
4. Herpes Labialis (Cold Sores) — Merck Manuals Consumer Version.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or before starting any new treatment.