Rashes in Children
General Information
Rashes are common in children and babies, with most caused by viral infections. Typically, these rashes are harmless and resolve on their own. Different viruses may produce rashes that appear similar, while others may lead to distinct skin changes.
Measles is an example of a virus causing a distinctive and contagious rash. If you suspect your child has measles, consult your GP immediately.
A rash with small, bright-red or purple spots that does not blanch when pressed warrants urgent medical attention, as it may indicate a serious condition.
Signs and Symptoms of Rashes
Rashes can present with various characteristics:
- Flat or raised areas: Rashes may appear as red, flat spots, raised bumps, or welts.
- Blisters: Some rashes may form blisters filled with fluid.
- Distribution: Rashes may spread across the entire body before resolving.
- Duration: The rash may persist for several days to weeks.
- Itching: While many rashes are mild and do not cause distress, some can be intensely itchy.
Common Viral Rashes in Children
For more detailed information about viral infections causing rashes, refer to specific fact sheets on conditions such as:
- Chickenpox: Typically presents with an itchy, blistering rash that crusts over.
- Hand, Foot, and Mouth Disease: Characterized by sores in the mouth and a rash on the hands and feet.
- Henoch-Schönlein Purpura (HSP): Causes a distinctive rash on the lower limbs and buttocks, often associated with joint and abdominal pain.
- Measles: Begins with high fever, cough, runny nose, and red eyes, followed by a red blotchy rash.
- Molluscum Contagiosum: Results in small, painless bumps on the skin.
- Roseola Infantum: Presents with a sudden high fever followed by a pinkish-red rash as the fever subsides.
- Slapped Cheek Syndrome (Fifth Disease): Causes a bright red rash on the cheeks, often spreading to the body.
When to See a Doctor
- Accompanying Fever: Many viral rashes are preceded by a fever, which usually indicates the body is fighting off the infection. If a fever accompanies the rash, it is advisable to consult a GP.
- Measles Concerns: Measles can be severe, especially for infants and young children. If suspected, contact your GP and alert the clinic upon arrival to prevent spreading the infection.
- Non-Blanching Rash: If your child has a rash that does not turn white (blanch) when pressed and is accompanied by fever, headache, stiff neck, or back pain, seek immediate medical advice, as this may indicate meningococcal disease or another serious condition.
Home Care Tips
- Viral Rash Management: In most cases, identifying the specific virus causing a rash is not necessary. Viral rashes generally resolve on their own, and antibiotics are ineffective.
- Itch Relief: Consult your pharmacist for appropriate treatments to alleviate itching.
- Comfort Measures: If the rash causes discomfort, follow general pain relief guidelines to make your child more comfortable.
Preventing Viral Infections
- Hand Hygiene: Wash hands thoroughly after contact with bodily fluids.
- Avoid Sharing Items: Prevent the spread of viruses by not sharing utensils, cups, towels, toothbrushes, and clothing.
Key Points to Remember
- Viral rashes are common and typically harmless.
- Seek medical advice if you suspect your child has measles.
- A rash that does not blanch when pressed, especially if accompanied by fever or systemic symptoms, requires urgent medical attention.
Differential Diagnoses of Rashes
- Viral Causes:
- Measles: High fever, cough, conjunctivitis, Koplik spots in the mouth, followed by a blotchy red rash.
- Chickenpox: Itchy vesicular rash that progresses to crusted scabs.
- Roseola: Sudden high fever followed by a pinkish rash as the fever resolves.
- Hand, Foot, and Mouth Disease: Mouth ulcers, fever, and rash on hands and feet.
- Bacterial Causes:
- Scarlet Fever (Group A Streptococcus): Red rash with a sandpaper-like texture, often following a sore throat.
- Impetigo (Staphylococcus aureus/Group A Streptococcus): Honey-crusted lesions on the face or limbs.
- Meningococcal Disease: Non-blanching petechial or purpuric rash, fever, and systemic symptoms like headache and neck stiffness.
- Mechanical Causes:
- Pressure-Induced Petechiae: Result from coughing, vomiting, or tight bandages.
- Non-Accidental Injury: Bruising or marks in unusual locations or shapes suggestive of inflicted trauma.
- Haematological Causes:
- Immune Thrombocytopenia (ITP): Sudden onset of petechiae or bruising due to low platelet count.
- Leukaemia: May present with petechiae, pallor, fatigue, and systemic symptoms.
- Disseminated Intravascular Coagulation (DIC): Petechiae and bleeding secondary to severe systemic illness.
- Other Conditions:
- Henoch-Schönlein Purpura (HSP): Palpable purpura, often on lower extremities, with abdominal pain and possible kidney involvement.
- Drug-Induced Rash: Reaction to medications, presenting with various rash patterns.
Chickenpox: Overview and Management
Chickenpox is an infection caused by the varicella-zoster virus. As a viral illness, antibiotics are ineffective for treatment; management primarily focuses on symptom relief, such as reducing fever and alleviating itching from the rash.
Transmission
Chickenpox spreads easily through direct contact with an infected individual or by inhaling fluid droplets from coughing or sneezing. An infected person is contagious from 1-2 days before the rash appears until all blisters have dried and scabbed over.
Vaccination
- In Australia, children receive a chickenpox vaccination at 18 months of age as part of their routine immunisation schedule. This vaccine is effective, with minimal side effects and is provided free.
- A booster dose may be given at least one month after the initial dose to enhance protection.
Signs and Symptoms
- Initial Symptoms: Mild fever, tiredness, irritability, and an itchy rash.
- Rash Characteristics:
- Appears 10 to 21 days after exposure (incubation period).
- Typically starts on the chest, back, or face, then spreads to other areas, including the mouth.
- Begins as small red spots that develop into fluid-filled blisters, eventually crusting over.
- Duration: Symptoms usually last 5-7 days.
Home Care
Most children with chickenpox can be managed at home. Since antibiotics are ineffective against viral infections like chickenpox, care focuses on symptom management:
- Itching Relief: Use topical creams or medications recommended by a pharmacist.
- Hydration: Encourage your child to drink plenty of fluids (water, jelly, icy poles, soup).
- Fever Management: Paracetamol may be used to reduce fever, but avoid aspirin and ibuprofen, which may cause complications.
When to See a Doctor
Consult a GP if your child:
- Develops large, red, sore areas around the rash, indicating a possible secondary bacterial infection.
- Becomes increasingly unwell, drowsy, has a high fever, or is not drinking fluids.
- Has an underlying skin condition (e.g., eczema) that may require specific advice for managing the rash.
In severe cases or for children with serious underlying health conditions, antiviral medication may be prescribed after exposure to chickenpox.
Important Considerations
If your child has a fever and a rash with small, bright red or purple spots that do not blanch (turn white) when pressed, this may indicate a meningococcal infection, requiring immediate medical attention.
How Chickenpox Spreads
- Highly Contagious: Chickenpox is easily transmitted by direct contact with blister fluid or through airborne droplets.
- Infectious Period: From 1-2 days before the rash until all blisters have dried.
- Precautions: Family members who are immunocompromised, pregnant, or taking long-term oral steroids should consult a GP if exposed.
Preventing Spread
Children with chickenpox should remain home from child care, school, or public activities until all blisters have dried. Inform your child’s school of the diagnosis, as other children may require immunisation or treatment.
Key Points to Remember
- Contagion: Chickenpox is highly contagious and spreads easily.
- Rash Onset: Appears 10-21 days after exposure.
- Antibiotic Ineffectiveness: Antibiotics do not work against chickenpox.
- Vaccination: Routine vaccination is administered at 18 months of age in Australia.
Henoch-Schönlein Purpura (HSP)
Henoch-Schönlein Purpura (HSP) is a condition characterized by inflammation (swelling and irritation) of small blood vessels, often resulting in a distinctive rash called purpura. In addition to affecting blood vessels in the skin, HSP can also impact the intestines and kidneys, though complications involving the lungs or brain are extremely rare.
Causes and Triggers
- Unknown Cause: The exact cause of HSP remains unclear, but it is commonly triggered by viral infections, such as colds.
- Seasonal Occurrence: HSP tends to occur more frequently in the spring.
- Age Group: It most commonly affects children aged 2 to 10 years but can occur at any age.
- Contagion: While HSP itself is not contagious, the underlying infection that triggers it may be.
Signs and Symptoms
Symptoms of HSP may develop gradually over days to weeks. The rash is nearly always present but may not appear initially.
- Rash: Small reddish-purple spots or bruises, often found on the buttocks, legs, and around the elbows.
- Swelling: Swollen feet, hands, and, in male children, the scrotum.
- Joint Pain: Pain and swelling in joints such as the knees and ankles.
- Stomach Pain: Abdominal discomfort is common.
- Blood in Stools or Urine: This may occur due to inflammation of blood vessels in the bowel or kidneys.
- Rare Complication: Intussusception (bowel folding/blockage) can occur, requiring surgical intervention.
When to See a Doctor
- Suspected HSP: Visit your GP if you suspect your child has HSP.
- Follow-Up Visits: Return to the GP if your child experiences increasing pain or swelling, blood in their urine or stools, or if you have any concerns.
- Urgent Signs: If your child has a non-blanching rash (small red or purple spots) accompanied by fever, this may indicate a serious condition like meningococcal infection, and you should seek immediate medical attention.
Treatment
- Medications: HSP often resolves on its own without medication. However, your GP may prescribe:
- Prednisolone: For severe stomach pain, joint pain, or to help prevent kidney complications.
- Infection Management: In some cases, treatment may address the underlying infection that triggered HSP.
- Pain Management: Pain relievers such as paracetamol or anti-inflammatory medications like ibuprofen can help reduce joint pain and general discomfort.
Home Care
- Pain Relief: Use paracetamol or ibuprofen for joint discomfort (see our fact sheet on pain relief for children).
- Monitoring: Observe your child for any worsening symptoms or new issues and consult your GP as needed.
Follow-Up Care
Long-term monitoring with your GP is crucial. Approximately 50% of children with HSP may experience a recurrence. Kidney involvement may develop in the first week or appear later, sometimes months after the initial illness. Your child’s doctor will regularly test urine samples and monitor blood pressure to check for kidney issues over a minimum of six months, with a final check at 12 months.
Key Points to Remember
- Inflammation and Rash: HSP causes small blood vessel inflammation, leading to a rash.
- Organ Involvement: It can also impact blood vessels in the kidneys and intestines.
- Pain Management: Paracetamol and anti-inflammatories can relieve joint pain.
- GP Consultation: Seek medical advice if your child has increasing pain, swelling, blood in their stools/urine, or for any concerns.
- Ongoing Monitoring: Long-term follow-up with your doctor is essential to monitor and manage potential kidney complications.
Measles: Overview and Management
Measles is a highly contagious viral infection characterized by fever and a distinctive red blotchy rash. It spreads through droplets from coughing and sneezing and is one of the most contagious diseases.
Vaccination in Australia
- The MMR vaccine (Measles, Mumps, Rubella) is given to children at 12 months, with a second dose (MMRV, which also includes Varicella) at 18 months.
- Two doses provide effective immunity, with a very low risk of contracting measles after full vaccination. However, unimmunised individuals have a 90% chance of becoming infected when exposed to the virus.
- While rare in Australia due to high vaccination coverage, outbreaks can still occur, often triggered by infected travelers from countries with low vaccination rates.
Signs and Symptoms of Measles
- Incubation Period: Symptoms typically appear 10-12 days after exposure.
- Early Symptoms: Fever, cough, runny nose, sore or red eyes, and lethargy.
- Rash Onset: A red, blotchy rash appears 2-3 days after the initial symptoms. It usually starts on the head and spreads downwards to cover the body.
- Duration: Most children recover within a week, with improvement seen about 2 days after the rash appears. However, the cough may persist for up to 2 weeks.
- Complications: In some cases, secondary infections such as ear infections, pneumonia, or gastrointestinal issues (diarrhea, vomiting) can occur. A rare but severe complication is encephalitis (brain inflammation).
When to See a Doctor
- If you suspect your child has measles or has been exposed to the virus, consult your GP immediately.
- If visiting a clinic, notify staff upon arrival to prevent spreading the infection.
- Your doctor may perform tests to confirm the diagnosis.
- Immunity following measles infection is usually lifelong, though reinfection is extremely rare.
Home Care for Measles
- Symptom Relief: Antibiotics are ineffective as measles is viral. Focus on comfort care:
- Rest: Ensure your child rests as much as possible.
- Hydration: Encourage frequent fluids to prevent dehydration.
- Fever Management: Paracetamol or ibuprofen can help reduce fever and relieve discomfort (refer to the Pain Relief for Children fact sheet).
- Return to GP if:
- Symptoms worsen.
- Your child starts vomiting or has difficulty drinking.
- They appear very tired or unusually sleepy.
- You have any concerns about their condition.
- Hospitalization: Some children may need hospital care if complications arise, such as severe dehydration or secondary infections.
When to Seek Emergency Care
- If your child develops a rash with changes in personality, confusion, memory loss, seizures, or paralysis, seek emergency care immediately.
- A rash with small, bright red or purple spots that does not blanch when pressed, particularly with fever, may indicate meningococcal infection and requires urgent attention.
Transmission and Contagion
- Measles is highly contagious, spreading through droplets and contaminated surfaces. Exposure can occur by simply being in the same room as an infected individual.
- High-Risk Groups During Outbreaks:
- Babies under 12 months (too young for full vaccination).
- Immunocompromised individuals.
- Pregnant women and children.
- People born after 1966 who have not had two doses of the measles vaccine.
Measles Outbreaks
- Measles outbreaks often occur when unvaccinated individuals bring the virus from abroad.
- Prevention: Ensure immunisation is up-to-date. Unimmunised individuals should speak with their GP or health services about vaccination.
Key Points to Remember
- Highly Contagious: Measles spreads easily through droplets and direct contact.
- Rare in Australia: Due to high vaccination coverage, measles is uncommon, but outbreaks do occur.
- Potential Complications: Measles can lead to serious complications, including encephalitis.
- Vaccination: Routine childhood vaccination is crucial for protection.
Molluscum Contagiosum: Overview and Management
Molluscum contagiosum is a common viral skin infection that causes small, raised, often painless spots on the skin. It is caused by the molluscum contagiosum virus and can spread easily to other people or different areas of the body through direct contact with the spots, contaminated water, towels, or bath toys.
Duration and Natural Course
- Molluscum spots may persist for a few weeks, several months, or even longer than a year.
- In most cases, the condition resolves without treatment.
Signs and Symptoms
- Initial Appearance: Molluscum spots often start as small, white pimples.
- Distinctive Features: They gradually develop into round, pearl-coloured lumps with a characteristic central indentation or dimple.
- Size: Typically, spots are 1-5 millimetres but can grow up to 2 centimetres in diameter.
- Common Locations: Spots may appear on the stomach, face, arms, legs, or nappy area.
- Painless and Non-Itchy: Generally, molluscum spots do not cause discomfort or itching.
How Molluscum Spreads
- Water Exposure: The virus thrives in warm water, so children often become infected through swimming pools or baths.
- Direct Contact: Sharing towels, face washers, or skin-to-skin contact with the spots can also spread the virus.
- Incubation Period: It can take weeks or months for spots to appear after exposure.
Prevention Tips
- Showers Over Baths: Encourage showers to reduce the spread within bath water.
- Avoid Sharing: Do not share baths, towels, face washers, or clothing with others.
- Drying: Dry areas with molluscum spots last to prevent spreading the virus to other parts of the body.
- Hygiene Practices: Wash hands thoroughly after touching molluscum spots, and clean and dry bath toys after use.
Treatment for Molluscum
- Self-Resolution: Molluscum often clears up on its own within 6-18 months and does not typically cause scarring if left untreated.
- When Treatment is Needed:
- Considered for unsightly lesions, those affecting quality of life, or in cases of weakened immunity where the infection may persist longer.
- If your child also has eczema, treat the eczema before addressing the molluscum.
- Potential Treatments: Options, such as topical therapies or procedures, may cause discomfort and risk spreading the virus or causing scarring. Consult with a GP, dermatologist, or dermatology nurse practitioner for appropriate management.
When to See a Doctor
- Secondary Infection: If the skin around the molluscum spots becomes red, swollen, or infected, see a GP. Antibiotics may be needed for the bacterial infection but will not treat the molluscum virus itself.
Key Points to Remember
- Cause: Molluscum is caused by a virus, producing small, painless, raised spots.
- Transmission: The virus spreads easily through direct contact, contaminated water, towels, and toys.
- Prevention: Good hygiene practices can help reduce the spread.
- Treatment: Often unnecessary, but antibiotics may be prescribed for secondary bacterial infections.
Roseola Infantum: Overview and Management
Roseola infantum is a common, typically mild viral infection that predominantly affects babies and young children. It is caused by a virus from the herpes family, though it does not lead to other herpes-related infections like cold sores. Historically, it has sometimes been referred to as “baby measles.”
Duration and Prevalence
- The illness generally lasts around four days and rarely requires medical treatment.
- Most symptoms are mild, and many parents may not even notice their child is infected.
- Age Group: Roseola mainly affects children aged 6 months to 2 years, with about 95% of children having been infected by age two.
- Contagious Period: Roseola is contagious before symptoms appear, making prevention challenging.
Signs and Symptoms
- High Fever: The illness typically begins with a sudden high fever, lasting 3-5 days.
- Rash: When the fever subsides, a red, raised rash may appear on the body and spread to the arms and legs. The rash rarely affects the face and usually lasts two days, blanching (turning white) when pressed.
- Variability: Some children may only experience a high fever without developing a rash.
- Febrile Convulsions: In rare cases, the sudden rise in temperature can lead to a febrile convulsion (seizure). Though distressing, these are usually not serious. See our fact sheet on Febrile Convulsions for more information.
How Roseola Spreads
- Mode of Transmission: Roseola is spread through airborne droplets released when an infected person coughs or sneezes.
- Contagion Timeline: Children can only transmit the virus before the fever and rash appear. Once symptoms are visible, they are no longer contagious.
- Prevention: There is no vaccine for roseola, and preventing its spread can be difficult. Good hand hygiene is the most effective measure to reduce transmission.
Care at Home
- Fever Management: Paracetamol may be given to reduce fever and make your child more comfortable (refer to our Pain Relief for Children fact sheet).
- Hydration: Ensure your child drinks plenty of fluids, such as water, breastmilk, or formula, to stay hydrated during a fever.
- Antibiotics: Not recommended, as roseola is caused by a virus and antibiotics are ineffective against viral infections.
When to See a Doctor
Consult a GP if your child:
- Becomes lethargic (very sleepy and difficult to wake).
- Has fewer wet nappies than usual (a sign of possible dehydration).
- Has a fever that does not improve after 48 hours.
- Experiences a convulsion (seizure) lasting less than five minutes.
Emergency Care
Call an ambulance immediately if:
- Your child has a convulsion lasting more than five minutes.
- Your child does not wake up after a convulsion.
- If your child develops a fever and a skin rash with small, bright red or purple spots or unexplained bruises that do not blanch (turn white) when pressed, seek immediate medical attention, as this may indicate a meningococcal infection (refer to our Meningococcal Infection fact sheet).
Slapped Cheek (Fifth Disease): Overview and Management
Slapped cheek, also known as fifth disease or erythema infectiosum, is a common viral infection caused by the human parvovirus B19. It primarily affects children between the ages of 4 and 10 years, although it can occur at any age. The infection typically causes mild symptoms, with a characteristic red rash on the cheeks giving it its name. Serious complications are rare.
Signs and Symptoms
- Incubation Period: Symptoms may appear 4 to 14 days after exposure.
- Initial Symptoms: Fever, headache, stomach upset, and general aches and pains.
- Cheek Rash: A bright red rash resembling slapped cheeks often follows a few days after initial symptoms.
- Body Rash: Some children develop a lace-like, pink rash on the chest, back, arms, and legs, which may come and go for weeks or even months, often triggered by sunlight or physical activity.
- Mild or No Symptoms: Many children show only mild symptoms or may not appear ill at all.
Transmission
- How It Spreads: Slapped cheek is transmitted through contact with respiratory droplets from coughs or sneezes of an infected person.
- Contagious Period: Children with slapped cheek are contagious until 24 hours after their fever resolves. They cannot spread the infection once the rash appears, even if it persists.
- Prevention: Keep children with a fever home from school or childcare to help prevent spreading the infection.
Care at Home
- Symptom Management: Since slapped cheek is caused by a virus, antibiotics are ineffective. Focus on rest to help the body recover.
- Fever and Pain Relief: Paracetamol or ibuprofen may be used to alleviate fever, aches, and pains (refer to our Pain Relief for Children fact sheet).
- Hydration and Comfort: Ensure your child is comfortable and stays hydrated.
When to See a Doctor
- Joint Pain and Swelling: If your child develops joint pain or swelling in their hands or feet, consult your GP for appropriate management.
- High-Risk Children: Children with sickle cell anaemia, severe anaemia, long-term steroid use, or those who are immunocompromised should be assessed by their GP if slapped cheek is suspected.
- Pregnancy: Pregnant women exposed to slapped cheek should consult their GP due to potential risks during pregnancy.
- Concerning Symptoms: If your child has a fever and a rash with bright red spots, purple spots, or unexplained bruises that do not blanch (turn white) when pressed, seek immediate medical attention, as this could indicate meningococcal infection (refer to our Meningococcal Infection fact sheet).
Key Points to Remember
- Symptoms Vary: The severity of symptoms can differ from child to child, with some having few or no symptoms.
- Viral Nature: Slapped cheek is caused by a virus, so antibiotics will not be effective.
- Contagiousness: Once the fever subsides for 24 hours, children with a rash are no longer contagious.