Overview of Viral Infections in Children: Viral Infections in Infants and Children: Merck Manual Home Edition

Children's Health Issues

Viral Infections in Infants and Children

Overview of Viral Infections in Children

In This Topic

Resources

Merck Manual
>
Patients & Caregivers
>
Children's Health Issues
>
Viral Infections in Infants and Children

Overview of Viral Infections in Children

Share This

view related topics in this manual

Viral infections are common among people of all ages but often seem to be concentrated in infants and children. Most childhood viral infections are not serious and include such diverse illnesses as colds with a sore throat, vomiting and diarrhea, and fever with a rash. Some viral illnesses that cause more serious disease, such as measles, are less common now due to widespread immunization. Several types of viral infections that children can acquire are discussed in the chapter on adult viral infections (see Viral Infections: Overview of Viral Infections).

Most children with viral infections get better without treatment, and many viral infections are so distinctive that a doctor can diagnose them based on their symptoms. A doctor usually does not need to have a laboratory identify the specific virus involved.

Many viral infections result in fever and body aches or discomfort. Doctors treat these symptoms with acetaminophenSome Trade Names
TYLENOL
or ibuprofenSome Trade Names
ADVIL MOTRIN
. Aspirin is not given to children or adolescents with these symptoms, because it increases the risk of Reye's syndrome in those who have certain viral infections. Generally, parents can discern whether their child is ill with a potentially serious infection and needs immediate medical care. This is particularly true for children beyond infancy.

Print Open table in new window

Some Viral Infections At a Glance
Infection	Period of Incubation	Period of Contagiousness	Site of Rash	Nature of Rash
Measles (rubeola)	7 to 14 days	From 2 to 4 days before the rash appears until 2 to 5 days after	In more severe cases, spreads over the trunk, arms, and legs Starts around the ears and on the face and neck	Begins 3 to 5 days after the onset of symptoms and lasts 3 to 5 days Irregular, flat, red areas that soon become raised
Rubella (German measles)	14 to 21 days	Infected newborns are usually contagious for many months From shortly before the onset of symptoms until the rash disappears	Spreads to the trunk, arms, and legs Starts on the face and neck	Begins 1 or 2 days after the onset of symptoms and lasts 3 to 5 days Fine, pinkish, flat rash
Roseola infantum (exanthem subitum or pseudorubella)	About 5 to 15 days	Unknown	Affects the chest and abdomen, with moderate involvement of the face, arms, and legs	Begins on about the 4th day, appearing as body temperature drops suddenly to normal, and lasts for a few hours to 2 days Red and flat, possibly with raised areas
Erythema infectiosum (fifth disease or parvovirus B19 infection)	4 to 14 days	From before the onset of the rash until a few days after	Spreads to the arms, legs, and trunk Starts on the cheeks	Begins shortly after the onset of symptoms and lasts 5 to 10 days May recur for several weeks Red and flat with raised areas, often blotchy and with lacy patterns
Chickenpox (varicella)	11 to 15 days	From a few days before the onset of symptoms until all spots have crusted	Appears later on the neck, arms, legs, and scalp and infrequently on the palms and soles Usually appears first on the face and trunk	Appears in crops, so various stages are present simultaneously Begins shortly after the onset of symptoms and lasts a few days to 2 weeks Small, flat, red sores that become raised and form round, fluid-filled blisters against a red background before finally crusting

Some Viral Infections At a Glance

Infection

Period of Incubation

Period of Contagiousness

Site of Rash

Nature of Rash

Measles (rubeola)	7 to 14 days	From 2 to 4 days before the rash appears until 2 to 5 days after	In more severe cases, spreads over the trunk, arms, and legs Starts around the ears and on the face and neck	Begins 3 to 5 days after the onset of symptoms and lasts 3 to 5 days Irregular, flat, red areas that soon become raised
Rubella (German measles)	14 to 21 days	Infected newborns are usually contagious for many months From shortly before the onset of symptoms until the rash disappears	Spreads to the trunk, arms, and legs Starts on the face and neck	Begins 1 or 2 days after the onset of symptoms and lasts 3 to 5 days Fine, pinkish, flat rash
Roseola infantum (exanthem subitum or pseudorubella)	About 5 to 15 days	Unknown	Affects the chest and abdomen, with moderate involvement of the face, arms, and legs	Begins on about the 4th day, appearing as body temperature drops suddenly to normal, and lasts for a few hours to 2 days Red and flat, possibly with raised areas
Erythema infectiosum (fifth disease or parvovirus B19 infection)	4 to 14 days	From before the onset of the rash until a few days after	Spreads to the arms, legs, and trunk Starts on the cheeks	Begins shortly after the onset of symptoms and lasts 5 to 10 days May recur for several weeks Red and flat with raised areas, often blotchy and with lacy patterns
Chickenpox (varicella)	11 to 15 days	From a few days before the onset of symptoms until all spots have crusted	Appears later on the neck, arms, legs, and scalp and infrequently on the palms and soles Usually appears first on the face and trunk	Appears in crops, so various stages are present simultaneously Begins shortly after the onset of symptoms and lasts a few days to 2 weeks Small, flat, red sores that become raised and form round, fluid-filled blisters against a red background before finally crusting

Enteroviral Infections: Common in Childhood

The enteroviruses include numerous strains of coxsackievirus, echovirus, enterovirus, and poliovirus. These viruses are responsible for illness in 10 to 30 million people each year in the United States, primarily in the summer and fall. Infections are highly contagious and typically affect many people in a community, sometimes reaching epidemic proportions. Enteroviral infections are most common among children, particularly those living in conditions of poor hygiene.

The infection begins when material contaminated with the virus is swallowed. The virus then reproduces in the digestive tract. The body's immune defenses stop many infections at this stage, and the result is few or no symptoms. Colds and upper respiratory infections are common outcomes of infection with enteroviruses. Sometimes, the virus survives and spreads into the bloodstream, resulting in fever, headache, sore throat, and, at times, vomiting. People often refer to such illnesses as the "summer flu," although they are not influenza. Some strains of enterovirus also cause a generalized, nonitchy rash on the skin or sores inside the mouth. This type of illness is by far the most common enteroviral infection. Rarely, an enterovirus progresses from this stage to attack a particular organ. The virus can attack many different organs, and the symptoms and severity of disease depend on the specific organ infected. Several diseases are caused by enteroviruses:

Hand-foot-and-mouth disease affects the skin and mucous membranes, causing painful sores to appear inside the mouth, on the hands and feet, and occasionally on the buttocks or genitals.
Herpangina also affects the skin and mucous membranes, causing painful sores on the tongue and the back of the throat.
Aseptic meningitis affects the membranes covering the brain and spinal cord (meninges), causing severe headache, stiff neck, and sensitivity to light.
Encephalitis affects the brain, causing confusion, weakness, seizures, and coma.
Paralytic poliomyelitis affects the nervous system, causing weakness of various muscles.
Myocarditis affects the heart, causing weakness and shortness of breath with exertion.
Epidemic pleurodynia (Bornholm disease) affects the muscles, causing severe intermittent pain in the wall of the lower chest (adults) or upper abdomen (children).
Hemorrhagic conjunctivitis affects the eyes, causing painful, red, runny eyes; bleeding under the conjunctiva; and swollen eyelids.

Enteroviral infections usually resolve completely, but infections of the heart or central nervous system are occasionally fatal. There is no cure. Treatment is directed at relieving symptoms.

Last full review/revision May 2007 by Mary T. Caserta, MD