Red Flags & When to Go In Person for Shingles (Herpes Zoster) - Pediatric Triage

Audience: pediatric

Shingles, also called herpes zoster, is a skin rash caused by the same virus that causes chickenpox. It can happen in children, especially if they had chickenpox before. Shingles usually causes a painful rash with blisters on one side of the body. Most children recover well with rest and care at home. However, some signs mean your child needs to see a doctor in person quickly. These include severe pain, rash near the eyes, fever, or weakness. Telemedicine can help check symptoms, give advice, and guide treatment, but it cannot replace a physical exam when serious problems arise. Knowing when to get in-person care helps keep your child safe and comfortable. This guide helps parents and caregivers understand red flags and how telemedicine fits into managing shingles in children.

Red flags — go in person / ER

• Rash or pain near or in the eyes (risk of vision damage) - go to emergency care immediately
• High fever (above 38.5°C or 101.3°F) lasting more than 2 days - seek urgent medical evaluation
• Severe pain not relieved by home care or medications - see a healthcare provider in person promptly

What telemedicine can do

• Initial symptom assessment and advice
• Guidance on home care and medication use
• Determining need for in-person evaluation
• Follow-up consultations for mild cases

What telemedicine cannot do

• Physical examination of rash and eyes
• Vision testing or eye-related emergencies
• Severe pain management requiring injections or IV therapy
• Treatment of complications such as bacterial infections or neurological symptoms

What is Shingles in Children?

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After a child recovers from chickenpox, the virus can stay inactive in the body and reactivate later as shingles. It usually appears as a painful rash with blisters on one side of the body or face. Children with weakened immune systems or who had chickenpox at a very young age may be more likely to get shingles.

Common Symptoms of Shingles

Typical signs include:

Symptoms usually last 2 to 4 weeks. Early treatment can help reduce pain and speed healing.

Red Flags: When to Seek In-Person Care

Some symptoms need urgent medical attention:

If you notice any of these, take your child to a healthcare facility promptly.

How Telemedicine Can Help

Telemedicine allows you to consult healthcare providers remotely. It can be useful to:

However, telemedicine cannot perform physical exams, vision tests, or urgent treatments that require hands-on care.

Preparing for a Telemedicine Visit

Before your tele-visit:

This helps the provider give better advice.

After the Telemedicine Visit: What to Do Next

Follow the provider's instructions carefully. Typical steps may include:

If your child's condition changes suddenly, seek in-person care immediately.

How to prepare for your tele-visit

• Have your child's medical and chickenpox history available
• Prepare to show the rash clearly on camera
• List all current symptoms and their duration
• Gather a list of current medications and allergies
• Find a quiet, well-lit place for the telemedicine call

After your tele-visit

• Follow prescribed medication instructions carefully
• Keep the rash clean and dry to prevent infection
• Monitor for new or worsening symptoms
• Schedule an in-person visit if symptoms do not improve or worsen
• Seek emergency care if red flags appear

FAQs

Can a child with shingles spread the virus to others?

Yes, children with shingles can spread the varicella-zoster virus to people who have never had chickenpox or the vaccine. The virus spreads through direct contact with the fluid from the blisters. Covering the rash and good hygiene help reduce the risk.

Is shingles common in children?

Shingles is less common in children than adults but can still occur, especially in those who had chickenpox early in life or have weakened immune systems.

How long does shingles last in children?

Shingles symptoms usually last 2 to 4 weeks. The rash typically heals without scarring, but pain may last longer in some cases.

Can shingles cause serious problems in children?

Most children recover without complications. However, shingles near the eyes or with severe symptoms can cause serious issues and need prompt medical care.

What treatments are available for shingles in children?

Antiviral medications may be prescribed to reduce the severity and duration of shingles. Pain relievers and soothing lotions can help manage symptoms. Treatment should be guided by a healthcare provider.

Sources

1. Shingles (Herpes Zoster) — MedlinePlus, U.S. National Library of Medicine.
2. Shingles (Herpes Zoster) - Symptoms and Causes — Centers for Disease Control and Prevention (CDC).
3. Herpes Zoster (Shingles) in Children — American Academy of Pediatrics.
4. Shingles (Herpes Zoster) — Mayo Clinic.

This telemedicine education is for informational purposes only and is not a substitute for in-person medical care. If your child has symptoms or red flags described here, seek prompt evaluation by a healthcare provider in person to ensure safe and effective treatment.