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Column originally published Sep 14, 2004

Herpes Virus Can Infect Children And Cause Cold Sores

Question: Our two-year-old son was admitted to the hospital two weeks ago. He had high fever for several days, and he refused to eat or drink. He got so dehydrated that our doctor had to give him IV fluid. His mouth was full of sores. We were told that he had a herpes infection. I was horrified because I had read, years ago, that one gets herpes infection through sex. I didn’t dare to ask the doctor any more questions. Now I am worried what I should tell our relatives if they ever ask us why our son was in the hospital. Can you tell us how he could have picked up this herpes virus?


You need to calm down right away. Your son did not pick up the virus through sex.

There is a whole family of Herpes viruses. The kind that you are talking about is herpes simplex virus, and there are two types of these. The one that is transmitted through sex is type 2, while the one that infected your son is type one. Unfortunately, they share the same name, and as a result, it has caused all kinds of misunderstanding, confusion, and heartache. Those who got infected by herpes simplex type 1 virus mistakenly thought that they contracted it through sex, and suffer this guilt silently without knowing the difference.

This type 1 virus is typically passed from one person to another through saliva. In young children, they put everything in their mouth, therefore they can pick up the virus through toys. Anyone who has had a previous infection with this virus can shed the virus in the saliva from time to time throughout life. Parents can also give the virus unknowingly to their children through kissing. There is no way of tracing the source of herpes simplex virus.

When a young child picks up the virus, it multiplies in the cells that cover the inside of the mouth and throat. Within days, many children would get sick with fever, sore throat, and sores inside the mouth, on the tongue, and in the throat. The tonsils can become very large. The gingiva, which is the gum around the teeth, becomes red and swollen. For many children, this acute phase can last several days. As long as they continue to drink, these children would recover fairly quickly.

However, some children, especially the younger ones, find that the pain is intolerable and would refuse to drink. Together with high grade fever, many would become dehydrated after several days. Some children would require intravenous fluid to get them rehydrated, like in your son’s situation. Fortunately, for most children, this type of herpes infection is restricted to the mouth and throat, and they recover eventually, although the process feels like forever.

Sometimes the virus infection can spread outside of the mouth, and sores can be seen on the lips, the cheeks, the fingers (especially if the child sucks them), and the eyes. Herpes infection of the eyes is a serious complication, because it can cause ulceration of the cornea. which can lead to blindness. A special eye drop containing anti-viral medication can effectively cure the infection in the eye.

Once recovered, these children continue to shed herpes simplex virus in their saliva from time to time, and can infect other children when they share toys or food. There is, however, no need to isolate these children from daycare or from school, after they have recovered from the acute illness. Other children who have not been infected can pick up the virus from those who have had previous infection, even years ago. Because this virus is so common everywhere around the world, almost all adults have evidence of prior infection some time in their life.

Both children and adults also can have recurrence of herpes infection in the form of cold sores. As the name implies, these sores usually occur around the lips, tend to happen when a person has symptoms of colds and fever. Excessive exposure to the sun, as well as stress, can also precipitate the development of cold sores.

The greatest problem occurs when children with immunodeficiency get infected with this herpes virus. These children can be born with a defective immune system, or when they are being treated with medications that suppress their otherwise normal immune system. In both situations, their immune system cannot control the spread of herpes virus from the mouth to other internal organs like the liver, the lungs, and the brain. These children can become extremely sick, and can die without anti-viral medications like Acyclovir.

Children with extensive eczema also require careful observation if they become infected with herpes simplex type 1 virus. The virus can easily penetrate the skin over eczematous areas, establishing new areas of infection. If a child has extensive eczema, the virus can infect most of the skin, and the condition is as serious as if the child has a defective immune system. These children also need Acyclovir to defeat the virus.

I hope this would give you insight into your son’s recent herpes infection. Don’t be afraid to tell your friends and relatives, if they ask, that your son had a infection from a virus that is identical to the cold sore virus, and that he has made a full recovery.