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

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. Has 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

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?

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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.