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What is scarlet fever?
Scarlet fever (once called scarlatina) used to be one of the most serious and deadly diseases of childhood. Today, it's treatable with antibiotics and is far less dangerous than it used to be.
Most often scarlet fever shows up in children 5 to 15 years of age, and it's very uncommon for children under age 2 to get it.
What causes scarlet fever?
Scarlet fever is basically strep throat with an accompanying rash. It starts as an upper respiratory infection caused by type A Streptococcal bacteria – the same bacteria that cause strep throat and some skin infections. The bacteria then release a toxin that causes the rash.
If your child has scarlet fever, he probably caught the strep infection from another child – from breathing infected droplets, sharing a cup or utensil, or touching something that the infected child handled, like a towel or a toy.
It's rare but also possible to develop scarlet fever from a strep skin infection such as impetigo, in which case your child would probably not have a sore throat
What are the symptoms?
Scarlet fever generally starts off with a sore throat, headache, and fever of 101 degrees Fahrenheit or higher.
Early in the infection, your child's tongue may have a white or yellowish coating. (Later, it may turn red.) The bumps on her tongue may appear larger than normal, a condition called strawberry tongue.
Your child's tonsils and back of her throat may also be coated, or they may appear red and swollen. Although your child's face will be flushed, the area around her mouth may be pale. Other symptoms include chills, aches, loss of appetite, swollen glands, malaise, nausea, stomach ache and vomiting.
The telltale rash commonly breaks out on the second day and typically lasts about two to five days. It usually begins as a mass of tiny red spots on the head and neck and spreads to the trunk and then the extremities. The bumps feel like fine sandpaper and may itch.
© Biophoto Associates / Science Source
The rash sometimes forms red streaks, called Pastia's lines, in the creases of the body, especially around the underarms, the inside of the elbows, and the groin. As the rash fades, your child's skin may peel, especially on the hands and feet and in the groin area.
How is scarlet fever treated?
If your child's doctor suspects scarlet fever or another type of strep infection, she'll perform a throat culture to confirm the diagnosis. All this requires is a painless swab of your child's throat to get a sample of the bacteria that are causing his symptoms. Then she'll give your child a prescription for antibiotics.
With treatment, recovery is fairly rapid, although the rash may linger for a few days. It may take several weeks for your child's tonsils and swollen glands to return to normal.
Left untreated, a strep infection can have serious complications, including throat abscesses or (rarely) rheumatic fever, which can cause long-term heart problems. So make sure that your child begins taking the antibiotics right away and that he takes the full dose for as long as the doctor prescribes, so the infection doesn't return.
Although it's possible to get strep throat multiple times, it's unusual to get scarlet fever more than once.
How can I make my child more comfortable?
- Give her acetaminophen or (if she's 6 months or older) ibuprofen to relieve discomfort and reduce fever. (Never give aspirin to a child. It can cause Reye's syndrome, a rare but life-threatening disease.)
- Offer your child soft or liquid foods such as soups, ice cream, and milkshakes. If her throat is extremely sore, swallowing may be painful. Warm or cold foods may appeal most to her. A little honey or warm tea with honey (if she's 1 year or older) may be soothing. (Don't give honey to a child before her first birthday, as it can cause a type of food poisoning called infant botulism.)
- Use a cool-mist humidifier to help her throat feel less dry and sore. Just be sure to clean the filter according to manufacturer's directions; otherwise, the device can add germs to the air.
- Make sure that she rests and drinks plenty of fluids.
When should I call the doctor?
Call for an immediate appointment if your child has a sore throat and a rash or any other symptoms of scarlet fever or strep throat (fever, swollen glands, or a white coating on the tonsils or the back of the throat).
If your child has been diagnosed with scarlet fever, call the doctor if he still has a fever or other symptoms 48 hours after starting antibiotics.
Is scarlet fever contagious?
The rash itself isn't contagious, but strep throat is. Your child won't spread the disease after she's been taking antibiotics for 24 hours, though.
During the first 24 hours, keep her drinking glasses, utensils, toothbrush, sheets, and towels separate from those of other family members, and clean them in hot, soapy water.
Family members or others who have contact with your child should be tested for strep infection if they develop a sore throat – with or without a rash. (You can carry the strep bacteria even if you don't have symptoms.) Have everyone wash their hands frequently.