A school-age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

A school-age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

• A. Topical antiviral medication
• B. Taking oral acyclovir for 5 to 7 days
• C. Topical diphenhydramine and Maalox
• D. Using a chlorhexidine gluconate rinse

Answer: (C)

When herpes stomatitis has been present for a week, the goal shifts to easing pain and keeping the child hydrated rather than pursuing antiviral therapy. Antiviral medications like acyclovir work best if started within the first few days of symptoms; starting them a week after onset typically provides little, if any, additional relief and isn’t the preferred approach at this stage. A soothing, protective approach is most helpful now. A topical mouthwash that combines diphenhydramine with Maalox provides pain relief and coats the mucosa, helping to reduce irritation from eating and drinking. The diphenhydramine contributes to local comfort, while Maalox acts as a demulcent, forming a protective layer over the ulcers. Other options don’t address the immediate need for comfort and mucosal protection. A topical antiviral isn’t likely to relieve pain at this point, and a chlorhexidine rinse, while useful for oral hygiene, doesn’t provide meaningful analgesia and can irritate or dry mucosa. So, the best course is symptomatic care focusing on pain relief and mucosal coating with a diphenhydramine and Maalox mouthwash, along with supportive measures like fluids and soft foods.

When herpes stomatitis has been present for a week, the goal shifts to easing pain and keeping the child hydrated rather than pursuing antiviral therapy. Antiviral medications like acyclovir work best if started within the first few days of symptoms; starting them a week after onset typically provides little, if any, additional relief and isn’t the preferred approach at this stage.

A soothing, protective approach is most helpful now. A topical mouthwash that combines diphenhydramine with Maalox provides pain relief and coats the mucosa, helping to reduce irritation from eating and drinking. The diphenhydramine contributes to local comfort, while Maalox acts as a demulcent, forming a protective layer over the ulcers.

Other options don’t address the immediate need for comfort and mucosal protection. A topical antiviral isn’t likely to relieve pain at this point, and a chlorhexidine rinse, while useful for oral hygiene, doesn’t provide meaningful analgesia and can irritate or dry mucosa.

So, the best course is symptomatic care focusing on pain relief and mucosal coating with a diphenhydramine and Maalox mouthwash, along with supportive measures like fluids and soft foods.