We get it. Babies are the cutest humans in the world that sometimes you can’t stop yourself from feeling gigil. But while it may feel right when you and your partner kiss and cuddle your little one, it can be extremely uncomfortable when relatives, friends, and even strangers plant a kiss on their face. That feeling is natural and justified — adults can easily pass on viruses and illnesses like cold sores in newborns.
A newborn’s immune system is still immature, and virus and bacteria that cause mild illness in older children can be devastating to them. In particular, cold sores in newborns and babies under 6 months old can lead to severe consequences.
What are cold sores?
Cold sores are tiny blisters that form anywhere on the face but most commonly on and around the lips, often at the edge. The blisters pop after a few days and then turn into a crust. They usually disappear within a few weeks.
Cold sores are contagious. It starts from the moment you first feel tingling or other signs of a cold sore appearing, like an itchy and burning sensation before the blisters become visible. These are most contagious when the blisters are visible.
Herpes simplex virus type 1 (HSV-1) is the virus responsible for cold sores in the lips, mouth, or throat. Although many think of it as a type of sexually transmitted infection (it is HSV-2 that usually causes genital herpes), one can get it without having sex. It is easily spread from skin-to-skin contact with someone who has the virus.
Cold sores are one of the symptoms of HSV-1 and are mainly transmitted by oral-to-oral contact, according to Dr. Suzanne S. Ponio-Degollado, MD, DPPS, DPIDSP, a Pediatric Infectious Disease Specialist who holds clinic at Jose B. Lingad Memorial Regional Hospital. She is also a member of the Pediatric Infectious Disease Society of the Philippines (PIDSP).
How do babies contract a cold sore?
If a pregnant woman has genital herpes (caused by HSV type 2), her baby can contract neonatal herpes through contact with fluids in the birth canal during vaginal delivery, according to Medical News Today. This is called vertical transmission and can happen even if the mother does not exhibit any symptoms.
However, this is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, says the World Health Organization (WHO). The risk for neonatal herpes is greatest if the mother gets HSV infection for the first time in late pregnancy. Neonatal herpes can lead to lasting neurologic disability or death.
Cold sores in newborns can also occur when a person who has it kisses the baby, according to the United Kingdom’s National Health Service (NHS). It can also spread if a mother has a blister caused by herpes on her breast, and she breastfeeds or feeds the baby with expressed breast milk from the affected breast.
People can be contagious without visible symptoms. A shared cup, toy, towel, or any other object can all transmit the virus. This is called horizontal transmission, or through contact after birth.
Why are cold sores dangerous and life-threatening for babies under six months of age?
A baby is most at risk of getting a herpes infection during the first four weeks of her life. “Infections are often severe in the neonatal period associated with high morbidity and mortality rates, even when antiviral treatment is given,” says Dr. Ponio-Degollado. “Aside from the local involvement of the skin, eyes, and or mouth, [the infection] can also [spread to] multiple organs like the liver, lungs, and even the brain."
Cold sores in newborns can lead to various complications “usually presenting as viral sepsis and severe hepatitis, putting them at high risk of death,” says Dr. Ponio-Degollado.
One mom shared a heartbreaking story of her newborn passing away after contracting HSV-1, which caused meningitis, an inflammation of the tissue that covers the brain and spinal cord. It is a potentially dangerous infection and can be fatal in some cases.
Warning signs of cold sores in newborns
Babies can quickly become seriously ill after catching the virus since their immune systems are underdeveloped. According to Dr. Ponio-Degollado, symptoms include:
- Poor feeding
- Vesicular rash or blisters
- Lethargy (also a primary symptom of viral sepsis)
- Signs of infection like respiratory distress
If your baby displays the symptoms below, take your baby to the doctor immediately, according to NHS:
- Lacking in energy (listless)
- Is becoming floppy and unresponsive
- Difficult to wake up from sleep
- Has breathing difficulties or starts grunting
- Breathes rapidly
- Has a blue tongue or lips
NHS warns that most often, your baby will not show any specific herpes symptoms, like a rash. But they will become unwell rapidly, so it is important to constantly observe your newborns.
How to prevent cold sores in newborns
Currently, there is no vaccine that can prevent HSV, according to Dr. Ponio-Degollado, so extra precaution is needed. Wash your hands regularly and thoroughly, especially before touching a baby. If you or any family member have cold sores and lesions, cover the area (use a mask if lesions are on the face) and avoid contact with the baby. Do not touch the sore and then approach the baby.
Use separate towels, washcloths, cups, and utensils for the baby. Teach older children to avoid kissing or sharing utensils with other people. If your baby is a thumb-sucker, the virus can transfer to his thumb or fingers and cause a painful blister called a herpetic willow. Also, make sure that babies and children do not rub their eyes if they have a cold sore or if they’ve come into contact with a person who has it.
Most importantly, avoid kissing or nuzzling the infant if you have an active lip or skin lesions, says Dr. Ponio-Degollado.
How to treat cold sores
Newborns who develop cold sores are usually admitted and are treated with an intravenous antiviral drug, according to Dr. Ponio-Degollado. This treatment might go on for several weeks. Complications that arise from the virus should also be treated.
The baby can be breastfed while she is receiving treatment unless the mother has cold sores around her breast. Moms should always remember to also wash their hands before breastfeeding.
For children with cold sores, Medical News Today suggests placing cold compresses on the blisters and taking pain relievers to lessen discomfort.
The best way to protect your babies from cold sores is to limit baby’s interaction with people, especially if they have an active sore. Establish rules for family members and be extra wary of strangers so they won’t accidentally kiss or touch your baby.
It can be hard to kiss your newborn — as a parent, it’s your instinct to do the action. But at least, for the first four weeks of his life, you can resort to giving him cuddles, skin-to-skin, and social interaction for now. After all, it is better to be safe than sorry.
This article was updated on July 9, 2019 at 2:12 p.m. to reflect Dr. Suzanne S. Ponio-Degollado's name.