Tips to Recognize Common Fever and Rashes in Children

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Your Child Has a Rash. Do You Know What to Do?

Rash 7

This is rash number 7 in the quiz below. Can you name it?

by James Hubbard, M.D., M.P.H.

Everyone with kids knows the drill. Your two-year old awakens you in the middle of the night with, “Mommy, I don’t feel vewy good,” or, “Daddy, my throat hurts.” You fumble around and find their forehead with an, “I sorry.” But yikes. This time they’re burning up.

You flip on the light, and the kid looks like he’s been in a naked paintball fight—red splotches everywhere. What do you do?

Okay, you’ll probably call the hospital, or the nurse’s hotline, or your primary-care doc. You might even go to the hospital. But what if you can’t? What if the roads aren’t travelable and all you’re getting on the phone is a busy signal?

Almost all children get high fevers some time or other. Most will get a rash or two. Sometimes it can be difficult even for professionals to tell which are routine and which are serious. I’m going to give you some tips on how I tell, but remember, this is for general information. A kid can fool you and look okay, then get very sick very fast.


First, Consider Your General Clues

Before getting into the rash specifics, get a handle on what you know and what you don’t. Ask yourself these two questions:

  1. Does the child look sick? Children usually don’t fake it, so forget the rash and fever for a minute and observe the child. If they’re just lying around, lethargic, not even trying to play, they’re probably pretty sick. Get them to a doctor as soon as possible, even in a disaster situation.
  2. "Duct Tape 911" | The Survival DoctorHas your child been exposed to a virus you know’s going around? If you know how sick the other children have been, this can make for an easier diagnosis.


Now, Look at the Rash

Take a good look. Ask yourself these questions:

  1. Where is it?
  2. Is it raised, flat or blistered?
  3. Does it itch?

These three questions will tell you a lot of what you need to know. Then you can match up those clues with your knowledge of common childhood rashes.

Wait … you say you don’t know a lot of common childhood rashes? Well, this is the perfect time for a little quiz! Let’s find out just how much you really (or really don’t) know!

Below, I’ve given clues to seven rashes. The answers are after each set of clues. How many can you get right?

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Pop Quiz! Common Rashes in Children

Rash 5

This is rash number 5. Don’t worry. The child pictured is feeling fine by this point.

(The first three rashes are usually accompanied by a fever.)

Rash 1
Where is it? On the palms, on the soles of the feet, and/or in the mouth.
Is it raised, flat, or blistered? Blistered.
Does it itch? No. It hurts.

Possible cause:
Think virus—specifically coxsackie virus, otherwise called hand, foot, and mouth disease. (See pictures here.) Viruses don’t respond to antibiotics. The main thing to do is to make sure the child drinks fluids to prevent dehydration. Any fluids without caffeine will do.


Rash 2

Where is it? It began on the face and trunk and may have spread to the extremities.
Is it raised, flat, or blistered? It started as raised bumps, but they’ll get tiny blisters on top, then break and crust over. More bumps will develop, so you’ll usually see all stages on the skin at once.
Does it itch? Yes, badly.

Possible cause:
The chickenpox virus, which lasts a week to ten days. (See a picture here.) Treat the itching with diphenhydramine (Benadryl), cool compresses, or oatmeal baths.


Rash 3

Where is it? All over.
Is it raised, flat, or blistered? Raised. It’s a fine, red rash all over the body that feels a little like sandpaper.
Does it itch? A little.

What to Do for a Virus

With the exception of rashes 3, 4, and 7, all the rashes I’ve named are viruses. If you can’t get professional medical help, there’s nothing you can do except try to keep the child comfortable and hydrated, and let the illness run its course.

For fevers over 102 Fahrenheit, give acetaminophen (Tylenol), or sponge the child off with lukewarm water. Never use alcohol or let the child get chilled. A fever suddenly brought down can trigger a febrile seizure.

Never use aspirin for fever in a child. It can increase risk for a life-threatening illness called Reye’s syndrome.

Possible cause:
Scarlet fever (pictured here). This is merely a strep infection with a rash. The child usually has a sore throat, but not always. That’s because the strep infection can be on the skin, even in the urine. Treat with an antibiotic such as amoxicillin, penicillin, or erythromcin. The child will usually get to feeling better in about 72 hours. It’s important to take the antibiotic for ten days to prevent the risk of rheumatic fever. (But see the next rash too.)


Rash 4

Where is it?
All over, random.
Is it raised, flat, or blistered?
It consists of raised, red splotches.
Does it itch?
Usually.

Possible cause:
Allergic reaction (as seen here). It could even be from the antibiotic. Stop the antibiotic and give diphenydramine (Benadryl).


(Rashes 5 and 6 develop after the fever has gone.)

IMPORTANT WARNING

Remember: Even during a disaster situation, if the child’s lethargic, confused, or hard to wake up, or if they won’t drink fluids, won’t stop crying, or just look sick, get them to a doctor as soon as possible.

Rash 5 (second photo)
Where is it? As soon as cold symptoms, such as a mild fever, disappeared, the child’s cheeks turned bright red. Next came a fine, red lacy rash over the body.
Is it raised, flat, or blistered?
Flat.
Does it itch?
Sometimes.

Possible cause:
Fifth disease. Also called slapped cheek disease. Official name erythema infectiosum. This viral illness is usually mild. The child usually feels fine, so do nothing. The rash will go away in a few days. You can see more pictures of this rash here.


Rash 6

Where is it? After a high fever that lasted two to five days, your child broke out all over in a pink rash.
Is it raised, flat, or blistered?
Flat.
Does it itch?
No.

Possible cause:
Roseola (as pictured here). The rash will last a couple of days.


(The following rash can be a sign of a life-threatening disease.)

The Glass Test

The glass test can be used for rash 7. For it, you press on the rash with a glass that has a clear bottom. The rash won’t fade.

Rash 7 (first photo)
Where is it?
It can be anywhere on the body, but there will be more than just one or two splotches.
Is it raised, flat, or blistered?
Flat. It looks like tiny blood blisters or red splotches underneath the skin. If you press on them, they don’t blanch or fade.
Does it itch?
No.

Possible cause:
Petechiae (more pictures here). Those blood blisters or red splotches are actually blood that has leaked out of the child’s tiniest blood vessels (capillaries). They can be a sign of a serious disease such as meningitis or sepsis. Get the child medical help if at all possible and as quickly as possible. One exception is if the child has been vomiting but looks pretty good otherwise. The strain of vomiting can cause the capillaries to bleed around the mouth. But the petechiae won’t be on the rest of the body.

 

Please share your experiences with our readers. I’m sure the parents and caretakers of little ones will be very appreciative. I know I will.

P.S. How many did you get right?

***
Don’t miss part 2!

By popular demand:
Can you name these five common children’s rashes?
***

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Photo of fifth disease by Andrew Kerr (own work) [public domain], via Wikimedia Commons.
Photo of Petichiae by Steve Morreale—DrGNU on Flickr.

  • mydiu

    My 2 years old girl has rash with no fever lasting for 2 weeks and doesn’t ease up. The hives began from her thighs and expanded to the whole body (back, belly, arms …. and cheek.) She is sometimes itchy but plays and eats normally. Doctor prescribed Fucidin -H cream and loratadin but it seems having no effect. There no unusual food or anything that she contacted. Does anyone know about this please?

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  • b pow

    Wow wish I had read this years ago. When we were on a game farm we were miles away from anywhere. My 9 month old baby woke up covered in spots. So i washed him down with water and covered him in talc powder. Unfortunately we had forgotten his nappies so he was dressed in a t-towell and plastic bag till we found the nearest town two hours away. The doc at the clinic wasnt sure what the rash was but his face was sure classic seeing the baby in a t-towell and plastic bag!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I’ll bet that was quite a sight.

  • Diamond

    Hi could you tell me what this looks like?

  • Masto

    I have a child with urticaria pigmentosa, which is a form of mastocytosis. UP is a lot like noticeable, chronic hives. We get asked if it’s chickenpox all.the.time.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing, Masto.

  • LCH Mom

    If any of your children have a rash that does not respond to treatment, be persistent. My son had an eczema like rash for months that ended up being a symptom of a rare cancer like illness called Langerhans Cell Histiocytosis. His case was severe and extremely hard to treat. Thankfully, he finally began responding to treatment and is doing well. I visited the doctor several times and even saw a dermatologist. It is rare and I am not intending to freak anyone out, but do be mindful of this potential disease. I poured over rash related websites for months looking for an explanation for my sons bumps and this one was never on my radar! A biopsy is the only way to know for sure but a skilled dermatologist should be able to help diagnose LCH. As mentioned by many others, if it does not respond to treatment (steroids), spreads rapidly, or is accompanied by a high fever, get it checked out!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Great advice. Thanks.

  • Samantha Gass

    My sister has a rash currently on her back that looks and feels similar to ringworm. She has had this all winter long and even part of the fall. NO BODY ELSE in the family has gotten it. She also works for 2 preschools and has not spread to any of the kids that she works with. I am an LPN and I think that it must be something else. She has done all of the medicines and treatments for ringworm and it hasnt gone away but it moves from body part to body part. Any help/Ideas would be greatly appreciated.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Samantha, just because no one else has gotten it doesn’t mean it isn’t ringworm. If it’s moving around she may need oral medicine. Of course, you’re right, it could very well be something else. Sounds like it’s time to see a doctor.

  • Tara

    My 10 year old daughter had a fever for 3 nights. After the fever was gone, on the fourth night, she developed this rash. Rash went away overnight, but came came 5th day and today (6th day). It is not itchy and goes away overnight, but comes back the next day. Is present on her face, chest, stomach, arms, legs and sometimes her back. She no longer has fever and seems fine otherwise. I have given her Benadryl, which did not help, so I’m assuming not an allergy. I have no idea what this is. If anyone can help, I would appreciate it. Will also call her dr tomorrow. Thinking maybe it’s viral.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Have you considered rash #5? Is anything going around in her class?

      • Tara

        Yes. That was what my dad suggested. Bumps are raised and not lacy. And checks are not rosy, but rather bumps are present all over her face. So I thought it was not Fifth Disease, but maybe this can have different forms, not just lacy. Thank you. Btw, I thought I attached a photo, but seems to not have uploaded. Thx!

        • Tara

          Trying to delete these two photos, but says only moderator can do that. They were supposed to be photos with face cropped out. Thanks

          • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

            Done.

  • Alex

    My Daughter has been feeling off for the last few weeks. she had a fever (not too high) and trouble sleeping. she now seems to have a bit of a cold. Last night she developed a rash all over her body that looks like the roseola pictures and woke up at 1am vomitting. Any suggestions? The doctors aren’t open yet and our hospital here is a bit of a joke to get in. should I make a trip to the bigger hospital in the town over?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Alex, that’s your call on how bad she looks. I can’t diagnose her specifically without an exam, but if is Roseola, then there’s not much to do other than give her something for the fever and have her drink fluids. Pedialyte is usually a good start. Another option is to call your regular doctor or whoever’s on call for him/her.