Uncovering Cold Sore Facts and Prevention Methods


 Children's Hospital Los Angeles RN Remedies Gloria Verret

Many of my blog posts are either inspired by or feature my daughter, but this particular topic—cold sores—was inspired by my oldest childhood friend. When we were young, she would call her cold sores “fever blisters,” which is a nickname for cold sores on the mouth. Cold sores are not pretty and she was ashamed of the sores and felt uncomfortable. Working in health care, I am often asked the questions:

  • What are cold sores?
  • What causes cold sores?
  • Why do children (and adults) get affected by them repeatedly?
  • How are cold sores prevented?

Continue reading for the answers and best practices to help your child when they experience cold sores.

Uncovering Cold Sore Facts and Prevention Methods What Are Cold Sores? 

A virus on the skin of the face, inside of the mouth and lips caused by the herpes simplex virus 1, otherwise known as HSV-1 (Because it is one of the eight known herpes viruses). HSV-1 is a condition seen all over the world and it is believed that 60 to 95 percent of all people have been infected at one time, many by age 15. The most susceptible individuals are newborns and children with health conditions such as malnutrition, immune deficiencies and skin conditions such as eczema.

The biggest issue for most children is pain and discomfort from cold sores, but also the social stigma from the visible cold sores. The sores can cause shame, fear and embarrassment. Children may be teased, which can lead to a loss of self-esteem. Keep reading for ways to prevent cold sores from affecting your child.

The lesions or “cold sores” can be painful and embarrassing but can also be life-threatening. Without proper treatment, the virus can be contagious and travel into the bloodstream and attack organs. There is no cure, but there are some medications. Further study is needed to find better medicines and a vaccine to prevent this virus. Once a person has HSV-1 in their system, it stays hidden in their body and can erupt again.

Most Common Ways Cold Sores Spread

The virus can be transmitted skin to skin, through body fluids or by sharing food, utensils, cups and toys. It can be transmitted even if the person who has the virus has no symptoms at the time. It is most contagious when the fluid has burst from the vesicle (or fluid-filled lesion) but it is contagious from the first warning tingle to the complete healing—even after the sore has crusted over. It can be spread from your child’s hands if they bite or suck on their fingers, and can also be transmitted if your child has eczema or other lesions or burns on their face.

The virus can also spread to:

  • The neck, ear, face and hands in school-age children who are participating in contact sports such as wrestling or water polo (About 7.6 percent of high school wrestlers get affected by cold sores and need to refrain from wrestling until it heals (5 to 14 days).
  • Your child’s genitals, which then becomes genital herpes (HSV-2).

Primary and Secondary Cold Sore Infection

The first outbreak of the virus is called “primary” and it may involve these symptoms:

  • Burning, tingling, pain or numbness at the site of the sore
  • Fatigue
  • Fever
  • Headache
  • Loss of appetite
  • Swollen lymph nodes

After the first time, it’s called a “secondary infection.” It is usually not as painful as the primary infection, and involves these signs and symptoms:

  • A feeling of burning, itching or tingling, followed by redness around the sore
  • Cold sores on the outer edge of the lips
  • Cold sores around the same place as the primary infection
  • Open sores that appear full of pus and then crust over

Some people get two outbreaks a year, while some get as many as six outbreaks a year.

Cold Sore Triggers

  • Certain foods (ask your child’s physician)
  • Emotional or physical stress
  • Fatigue
  • Illness such as the common cold
  • Lowered immune system
  • Menstruation
  • Overuse of alcoholic beverages
  • Pregnancy

Environmental triggers also cause cold sores to erupt, including:

  • Severe hot or cold weather
  • Trauma to the face
  • Prolonged exposure to the sun
  • Wind

Cold Sore Treatment

While there is no cure for cold sores, there is treatment. Cold sore treatment depends on the severity of the outbreak. The goal is to decrease pain and the length of time before the cold sore heals. There are topical antiviral creams and anesthetic creams for milder outbreaks. More severe infections may require oral antiviral medications and non-steroidal anti-inflammatory pain medications such as acetaminophen or ibuprofen. The most severe infections may require intravenous medications in a hospital setting.

Preventing Cold Sores 

You can begin preventing cold sores from affecting your child as early as today with some helpful tips:

  • Avoid extreme weather temperatures (if possible), such as below freezing and very hot temperatures
  • Clean your child’s toys thoroughly
  • Do not allow sharing of eating utensils, cups, food, makeup and other personal hygiene items
  • Encourage regular exercise and a well-balanced diet of fresh fruits and vegetables
  • Encourage your child to cover their mouth when they cough and sneeze
  • Remind your child not to kiss babies and children, even on the cheek, if there is a cold sore present
  • Get nutritional support from a registered dietician (if needed)
  • If your child is sick, they should stay home and rest
  • Keep your child’s emotional and physical stress levels low
  • Make sure your child gets eight hours of sleep per night
  • Model and teach good hand washing
  • Recognize the triggers that cause cold sores in your child and keep an eye out for signs that an outbreak is coming
  • Stay away from sick people
  • Teach your child not to touch their eyes, nose and mouth
  • Use lip balm or petroleum jelly to keep your child’s lips from cracking (Some lip balms have sunscreen built in—those are good to use when out in the sun)
  • Use sunscreen of SPF 15 and greater

As with many of the skin conditions in previous blogs, there are some common themes: exercise, a well balanced diet, plenty of rest and good hand washing come to mind immediately!

Many thanks to Mary Virgallito, MSN, RN, CIC, clinical administrator, Infection Prevention and Control at Children’s Hospital Los Angeles, for her advisement on this RN Remedies blog post.