What should I do if my baby has herpes sores in the throat?
If an infant develops herpes simplex virus (HSV) infection in the throat—often presenting as painful oral or pharyngeal vesicles, ulcerations, fever, irritability, poor feeding, or drooling—it constitutes a serious medical condition requiring prompt evaluation and management. Neonatal and infant HSV infections are potentially life-threatening due to immature immune responses and risk of dissemination to the central nervous system (CNS), lungs, or liver. Any suspected HSV infection in an infant under 6 weeks of age is considered a medical emergency and warrants immediate hospital admission for diagnostic testing—including viral PCR from oral swabs, CSF, blood, and urine—and empiric intravenous acyclovir therapy.
For infants aged 6 weeks to 3 months with localized oral HSV (e.g., gingivostomatitis without systemic signs), outpatient management may be considered only after thorough clinical assessment confirms absence of fever, dehydration, lethargy, or respiratory distress—and only if reliable follow-up is assured. However, many clinicians still recommend IV acyclovir for infants under 3 months due to unpredictable disease progression. Oral acyclovir is not recommended as first-line therapy in this age group because of variable absorption and insufficient data on efficacy and safety.
Supportive care remains essential: maintaining hydration (via small, frequent oral feeds or nasogastric tube if needed), managing pain with acetaminophen (avoiding ibuprofen in young infants and never using topical anesthetics like lidocaine, which carry aspiration and methemoglobinemia risks), and strict contact precautions to prevent transmission. Breastfeeding should continue unless active lesions are present on the breast; in that case, expressed milk may be fed while lesions are covered and hygiene is rigorously maintained.
Parents must be counseled to monitor closely for red-flag symptoms—including new or worsening fever, decreased urine output, lethargy, bulging fontanelle, seizures, or respiratory difficulty—and seek urgent medical attention if any arise. Prognosis is excellent with timely antiviral treatment, but delays significantly increase morbidity and mortality. Prevention includes avoiding close contact with individuals who have active cold sores and practicing meticulous hand hygiene around infants.