In the February 2008 edition of the "Journal of Oral Pathology and Oral Medicine," dentists Paolo G. Arduino, D.D.S., M.M.Sc., and Stephen R. Porter, D.D.S., Ph.D., estimate that between 30 and 60 percent of American children carry the herpes simplex virus that causes cold sores. Some experience no symptoms so mild that they go unrecognized. Others experience the painful blisters commonly known as cold sores.
Indications
Cold sores usually resolve within 10 to 14 days with no treatment at all, according to Arduino and Porter. However, the authors recommend antiviral drugs because children are more likely than adults to experience sores inside the mouth, which interfere with eating, drinking and oral hygiene. In addition, the authors note, cold sores can be traumatic and stigmatizing for children, especially those who attend daycare centers or school.
Types
In the June 9, 2008, edition of "Archives of Internal Medicine," dermatologist Christina Cernik, M.D., explains that doctors typically prescribe one of three drugs--acyclovir, valacyclovir or famciclovir--to treat children with cold sores. Acyclovir is the only drug approved by the Food and Drug Administration to treat children of all ages, including infants. Valacyclovir is approved for children 1 and up. Famciclovir is approved for children 13 and up. All of the drugs work the same way.
Dosing and Administration
Children take all three drugs by mouth. Acyclovir comes in liquid form for children who are too young to swallow tablets. Valacyclovir and famciclovir come in tablet form only. Doctors base the specific dose on the child's weight, age and the presence of other health problems, such as kidney disease. A common starting point, according to Cernik, is 10 mg per kg of body weight. Valacyclovir and famciclovir last longer inside the body, so children usually take them two or three times per day, compared to five times per day for acyclovir.
Safety
In the 2008 edition of "Basic and Clinical Pharmacology," University of California-San Francisco professor Sharon Safrin, M.D., says that cold sore antiviral treatments are generally considered safe and well-tolerated. Side effects occur in fewer than 10 percent of patients and typically include headache, nausea, vomiting or diarrhea.
Effectiveness
Cernik says that antiviral drugs can decrease the duration of a cold sore outbreak in children by about five days for the first outbreak and one or two days for a subsequent outbreak. In addition, Cernik says, antiviral drugs can reduce the number of days a child actively sheds the virus from five days to one, an important consideration for children who attend daycare or school.
Supportive Care
HealthyChildren.org, the American Academy of Pediatrics' patient information website, recommends treating fever or discomfort due to cold sores with over-the-counter acetaminophen. For more severe pain, a pediatrician can prescribe a mouth rinse that contains local anesthetics. Parents and caregivers should also provide a soft, bland diet with plenty of cool, non-acidic fluids such as water or apple juice to prevent additional irritation to skin and mouth sites affected by cold sores until the sores resolve.
References
- "Archives of Internal Medicine"; "The Treatment of Herpes Simplex Infections; Christina Cernik, M.D., et al.; June 9, 2008
- "Basic and Clinical Pharmacology, 11th Edition"; Bertram G. Katzung, M.D., Ph.D. et al.; 2008
- HealthyChildren.org: Oral Herpes
- "Journal of Oral Pathology and Oral Medicine"; Herpes Simplex Virus Type 1 Infection; Paolo G. Arduino, D.D.S., M.Sc. and Stephen R. Porter, D.D.S, Ph.D.; Feb. 2008
