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. Books adHas 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.

  • 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.

  • Jenny

    Has anyone heard of ‘Caps’ disease? It is only found by a certain blood test…. There are three levels of this condition… A rash goes with everyone of them… It’s actually hives that are brought out with a change in the barometric pressure and bring pain… It is genetic and can now be treated…. It’s worth the research…..

  • rachel

    my 18 months old daughter was diagnosed with tonsilitis a week before the she got rashes on her trunk and back and now slowly going to her extremities. a week before the rash the doctor prescribe antibiotic for 5 days since she had fever for 4 days of 39 degree celcius,. i brought her back to her doctor just today to check with the rashes and the doctor said it is just an allergic reaction to something which i doubt because it doesnt look like a typical rash to me. i attached picture so anyone can see.. the doctor prescribe a benadryl. hope it will heal soon… i felt bad seeing it so bad all over her trunk and back and now some on her legs. :( any insight on this? thanks

  • myndi rice

    Add eurothema multiform

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

      Thanks, Myndi. That one usually is an allergic reaction from something, but the something can sometimes be an infection.

  • edie

    My four year old daughter started with red rosy cheeks that appeared out of nowhere and went away the next day. Two days later she had high fever peaking at 103.7 for about a day in a half and the redness in her cheeks accompanied the fever. The next day her fever and cheek redness was gone now her arms and mainly hands look noticeably redish purple like she was sunburned on the back of arms they look like fish-net patterned. she has a cough now with the rash. Her energy has returned but not all the way. Any ideas as to what this could be?

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

      Not all viruses go by textbook symptoms. For instance, fifth disease. However, if you have specific concerns you should talk to her doctor.

  • Steven Scott

    Great stuff! I am an RN and work with humanitarian medical teams in Vietnam with Vets With a Mission. Lots of kids! Lots of rashes! Very usefull post…thanks.
    http://www.vetswithamission.org

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

      Thanks, Steven.

  • FrancheskaH

    My daughter is 9 months old with a slight fever on and off for a few days, but the same energy and appetite. Has alittle diharea but she is teething and for 3 days now she’s had a rash spread from her torso to her back, face and now legs but does not itch nor is fussy at all. There flat and pinkish with no pain. What could it be?? And should I risk going to dr and getting her sick from all the other kids when it’s not really bothering her?

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

      I can’t diagnose individuals without an exam. In general, from the symptoms, a simple viral rash would be an option, especially if it goes away in a few days to a week. But, you should call your doctor’s office, talk to the nurse or doctor, and see if you should bring her in.

  • Jen

    You should cover excema as well. My son has had it for 6 months now…its very difficult to deal with.