Question

Parents of a child with varicella ask the nurse how soon their child can return to daycare. The nurse should tell the parents that the child is contagious: A. Only when the papular rash is present B. When vesicles begin to appear C. Until all the lesions have crusted D. For one week after the lesions have faded

Short answer

Answer: A child with varicella is no longer contagious and may return to daycare when all the lesions have crusted over.

Step-by-step solution

Analyze the Question

First, let's analyze the question. We need to identify when a child with varicella is not contagious, as that's when they may return to daycare. Understanding the stages of varicella and when a person is contagious will help us find the correct answer.

Understanding Varicella Stages

Varicella, or chickenpox, goes through several stages during its course: 1. Papular rash: Small, raised, red, itchy bumps that develop on the skin. 2. Vesicles: Clear, fluid-filled blisters that form from the papules. 3. Crusting: As the vesicles break, they form a crust or scab that covers the lesion. Children are contagious from the vesicle stage until all the lesions have crusted over.

Comparing Answer Choices to Varicella Stages

Now let's compare our understanding of varicella stages and contagion to the answer choices provided: A. Only when the papular rash is present - This is incorrect, as children are still contagious during the vesicle stage. B. When vesicles begin to appear - This is partially correct, but it doesn't indicate when the child is no longer contagious. C. Until all the lesions have crusted - This statement correctly indicates when the child is no longer contagious and can return to daycare. D. For one week after the lesions have faded - This is incorrect, as the child is no longer contagious once all the lesions have crusted over.

Select the Correct Answer

Based on our understanding of varicella stages and when a child is contagious, we can confidently choose answer C, which states that the child is contagious until all the lesions have crusted. This is the point at which they can return to daycare, as they are no longer contagious at this stage.

Key concepts

Understanding Varicella Infection in Children

Varicella, commonly known as chickenpox, is a highly contagious viral infection that is most prevalent among children, although it can occur at any age. The main symptom of a varicella infection includes an itchy rash that progresses through several stages before healing. Key symptoms of varicella in children include:

• **Fever:** This can be one of the first signs of varicella, where the child may experience a mild to moderate fever.
• **Rash:** The varicella rash typically starts as small red spots that can appear all over the body.
• **Blisters:** These red spots evolve into fluid-filled blisters that eventually burst and form scabs.
• **Crusting:** After the blisters burst, scabs form over the sores, marking the beginning of the healing process.

These stages of varicella can cause significant discomfort for children, hence the need for attentive care and monitoring throughout the illness. It is important to understand these stages not only to provide effective care but also to prevent the spread of infection to others.

Navigating the Contagious Period of Chickenpox

Knowing when chickenpox is most contagious helps contain the infection and protect other children from getting sick. The contagious period for chickenpox begins approximately one to two days before the rash appears, when the child might not even know they are sick. It continues through the following stages until the rash has fully crusted over:

• **Pre-rash phase:** Even before the rash develops, the virus can spread to others.
• **Rash to blisters:** After the rash appears and progresses to blisters, the risk of contagion is high.
• **Crusting**: The child remains contagious until all blisters have formed scabs, which typically takes about five days after the onset of the rash.

Parents and caregivers must ensure that children with chickenpox stay away from school, daycare, and other public places until all blisters have crusted to avoid transmission of the virus. The end of the contagious period is marked by the complete crusting of the rash, not just when symptoms subside.

Returning to Daycare After Chickenpox

After a bout with chickenpox, parents and caregivers often wonder when it is safe for a child to return to daycare without posing a risk to others. The key point of return is when the child is no longer contagious.

• **Crusted lesions:** A child can safely return to daycare once all chickenpox blisters have formed scabs.
• **Absence of fever:** It is advisable to ensure the child is also fever-free without the assistance of fever-reducing drugs.
• **Well-being:** Lastly, make sure the child feels well enough to participate in normal activities.

Answer C from the exercise provides the accurate timeline for when a child with varicella can return to daycare. Parents should follow this guidance and check with the daycare facility for any additional requirements or policies they might have. A clear line of communication between healthcare providers, parents, and daycare staff is crucial to ensure the well-being of all children and staff at the facility.