Cold sore living in infants

Overview

Cold sores are small, fluid-filled blisters that usually appear on or around the lips. They are caused by the herpes simplex virus (HSV). In infants, cold sores can be more serious because their immune systems are not fully developed.

Cold sores are common in older children and adults, but less common in young infants. However, when they occur in infants, they need medical attention.

Infants, especially those under 6 months old, are at higher risk for severe illness. Newborns can catch the virus from a person with an active cold sore through contact, such as a kiss.

Symptoms

Common symptoms

• Tingling or burning on the lip or skin before blisters appear
• Small, painful, fluid-filled blisters on or around the lips
• Blisters may break open and crust over

Symptoms in children

• Same as common symptoms, but infants may also be irritable and have trouble feeding
• Blisters can sometimes appear inside the mouth (gingivostomatitis)

Symptoms in older adults

• Older adults may experience similar symptoms but rarely have severe complications.

Causes

Main causes

• Herpes simplex virus (HSV) type 1, and rarely type 2
• The virus enters through a break in the skin or through the mouth
• Infants usually catch the virus from a person with an active cold sore, often through kissing or sharing utensils

Risk factors

• Infants under 6 months old
• Having a weakened immune system
• Exposure to someone with an active cold sore
• Parents or caregivers who have a history of cold sores

When to see a doctor

See a doctor urgently if:

• If the infant is under 3 months old and has any cold sore
• If the infant has a fever
• If the infant is lethargic or not feeding
• If blisters are near the eye

Book a routine appointment if:

• If the infant has a cold sore and you are unsure how to care for it
• If the cold sore does not heal within 10–14 days
• If the cold sore keeps coming back

Diagnosis

A healthcare provider can usually diagnose a cold sore by looking at the blisters. They may ask about symptoms and any known exposure to the virus.

Tests that may be done

• In some cases, a swab from the blister can be tested to confirm the virus.

What to expect at your appointment

The doctor will examine the infant and may recommend treatment to reduce symptoms and prevent spread. They will also advise on home care and when to return if symptoms worsen.

Treatment

Treatment for cold sores in infants depends on their age and the severity of the infection. The main goals are to relieve discomfort, prevent dehydration, and stop the virus from spreading.

Self-care at home

• Keep the infant comfortable and offer plenty of fluids to prevent dehydration
• Clean the blisters gently with sterile saline or cool water
• Avoid touching the blisters and wash hands often
• Do not kiss the infant if you have an active cold sore

Medical treatments

For infants, especially those under 6 months, a doctor may prescribe antiviral medication in liquid form to help fight the virus. These medications can reduce the duration and severity of the outbreak. Always follow the doctor's instructions exactly. Do not give any over-the-counter cold sore creams to infants without checking with a healthcare provider first.

Living with this condition

While the infant has a cold sore, keep them comfortable and watch for any signs of worsening. The blisters may be painful, so gentle care is important. The virus can spread easily, so avoid direct contact with the sores.

Lifestyle tips

• Do not share towels, cups, or utensils with the infant while they have an active sore
• Avoid kissing the infant, especially near the mouth
• If you have a cold sore, wash your hands frequently and consider wearing a mask to avoid spreading

Diet and exercise

Infants should continue their regular feeding routine. If the cold sore makes sucking painful, the doctor may suggest a different feeding method, like using a syringe or cup for small amounts of milk. Keep the infant hydrated.

Mental health and emotional wellbeing

Caring for an infant with a cold sore can be stressful and worrying for parents. It is important to remember that most cases are manageable with medical guidance. Reach out to your support network if you feel overwhelmed.

Prevention

Cold sores can often be prevented by avoiding contact with people who have an active outbreak. If you or other family members have cold sores, take precautions like not kissing the infant and washing hands thoroughly before handling the baby.

Complications

If left untreated

• Dehydration if the infant is not feeding well
• Spread of the virus to other parts of the body, such as the eyes or brain (herpes encephalitis)
• In very rare cases, severe infection can be life-threatening in newborns

Long-term outlook

With prompt medical care, most infants recover fully from a cold sore without long-term problems. The virus stays in the body but may become inactive. If your infant has had a cold sore, future outbreaks are possible but usually milder. Always follow your healthcare provider's advice to keep your baby safe.

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