The first time you see an angry red rash on your soft-skinned baby you are likely to panic. But you will soon discover that rashes are quite common in early childhood, and seldom require a visit to the doctor or the emergency room. In fact, many rashes come and go before the staff at the doctor’s office can return your call (and quite often you never learn the cause of the rash).
If a rash persists for several days, or if it worsens, contact your child’s health care provider. In general, seek immediate medical attention if your child has fever, breathing difficulties, or persistent vomiting in addition to the rash. And be aware that rashes known as petechiae and purpura (read on for more details) require immediate medical attention.
Common childhood rashes: how to identify them & when to worry
Some rashes are a sign of a viral infection that simply needs to run its course; others are the result of an allergic reaction; and still others are caused by some type of irritant. Here are the 10 most common childhood rashes and when you should call the doctor:
1. Bull’s-eye rash
If you live in an area where Lyme disease is prevalent, you will want to know the appearance of erythema migrans rash, a.k.a. the “bull’s-eye” rash. This rash may begin at the site of a tick bite or elsewhere and can appear up to 30 days after your child is bitten, or not at all. The middle of the rash is pink or red, surrounded by a clear ring, and then another dark circle. The affected skin may be warm to the touch, but it is seldom itchy or painful.
If you see a bull’s-eye rash, contact your child’s health care provider right away. Antibiotics are used to treat Lyme disease, and the sooner your child begins treatment, the better the outcome.
2. Contact dermatitis
Contact dermatitis occurs when your child comes in contact with a substance that can cause skin irritation or an allergic reaction. Symptoms can include redness and itching, along with bumpy, scaly, or swollen skin. Irritants may include soaps, laundry detergents, household cleaners, cosmetics, fragrances, jewelry, or plants. It is important to try to identify the cause of the rash, so that your child can avoid future contact. Contact dermatitis isn’t contagious or life-threatening and the rash usually disappears within 2–4 weeks, assuming there is no further exposure. In the meantime, your child’s health care provider may recommend an antihistamine and cool compresses to relieve the itching.
Eczema, also known as atopic dermatitis, is a chronic condition that often appears in children with a family history of allergic disease. It is characterized by red, dry, peeling skin, and small, fluid-filled bumps that ooze a clear liquid. Eczema often begins with itchy, red bumps on the forehead, scalp, or cheeks that spread to the arms or trunk in children 2–6 months of age. Later in childhood, eczema is scalier and appears in the skin folds and creases found at the elbows, knees, wrists, and ankles. While there is no cure for this particular skin condition, nearly 60 percent of children outgrow eczema.
Pediatricians often treat eczema with non-steroidal or steroid creams or ointments and sometimes suggest an antihistamine to relieve the itching. Parents are also advised to avoid giving children with eczema long, hot baths and to moisturize their skin daily with an unscented ointment (ointments often stay on the skin longer than creams). For more skincare tips for children with eczema, read this.
4. Fungal rash
Most children experience some form of fungal rash at one time or another. In young children, it’s often caused by candida albicans, a yeast-like fungus. Symptoms include bright, red, angry-looking diaper rash (along with bumpy, swollen skin). Fungus thrives in dark, damp places. Letting your child spend time each day without a diaper, and patting (rather than rubbing) the skin dry after a bath are among the best treatment strategies.
When fungal infections occur in the mouth (look for white patches on your baby’s cheeks and gums) they are referred to as thrush. Thrush can be passed from the baby’s mouth to the breastfeeding mother’s breast and nipple and back again; the mother’s symptoms often include stabbing pains in the breast, and nipples that are itchy or burning, pink or red, cracked, shiny, and flaky. Although not a serious condition, for babies, thrush can be uncomfortable. Babies with thrush may be reluctant to breastfeed or bottle-feed because their mouths are sore.
Contact your child’s health care provider if you see signs of a candida infection –- either as diaper rash or thrush. An antifungal cream or an oral medication may be needed.
5. Heat rash
Heat rash appears as tiny red and/or pink pimples. These pimples can show up anywhere, but are usually found on your baby’s head, neck, and shoulders. Heat rash is common during hot, humid weather and often appears when an infant is wearing too many layers of clothing. If you see this type of rash on your child, move him to a cooler place. To prevent heat rash, dress your child in lightweight, loose fitting clothing in warm weather and layers that can be easily removed in cooler weather. The rash will usually go away by itself.
Also known as urticaria, hives are raised pink or white bumps on the surface of the skin. They often appear on the back, chest, and stomach, but can also be seen on the extremities and the face. Hives can be alone or in clusters, and often come and go within a 10–15 minute period. While hives, according to the American Academy of Allergy, Asthma and Immunology (AAAAI), can be the result of non-allergic triggers such as heat or exercise, more often than not, the appearance of hives are part of an allergic response to medication, food, or an insect bite.
When you or your child has an allergic reaction to a substance, your body releases histamine into your bloodstream which causes your skin to swell. Hives may itch, but they are not contagious. The most common treatment for hives is an over-the-counter antihistamine such as Benadryl, but parents should contact their child’s health care provider for dosing instructions. Parents should seek urgent medical care for their child if hives are accompanied by other symptoms, especially difficulty swallowing or breathing or vomiting. Your child’s health care provider may recommend that your child see a board certified allergist in order to identify the allergens and devise a treatment plan.
Impetigo (a contagious, bacterial infection) causes sores that most often occur around the mouth and nose. The sores can erupt on healthy skin, but impetigo usually occurs when bacteria enter the skin through cuts or insect bites. Either way, the rash will likely clear up on its own within 2–3 weeks. Though impetigo is rarely serious, your child’s pediatrician may still prescribe an antibiotic to prevent possible complications.
8. Petechiae & Purpura
Petechiae are flat, round spots that look like pinpoints and indicate bleeding under the skin. These spots can be red, brown, or purple, and are usually smooth to the touch. The spots don’t lose color when you press on them. Similarly, purpura, which also indicates that there may be ruptured blood vessels under the skin, are larger spots that may initially be red and then turn purple or brownish-yellow. Because this type of rash may signal a serious underlying condition, it is important that you contact your child’s health care provider right away if you see petechiae or purpura.
9. Urushiol rash
Poison ivy, poison oak, and poison sumac all contain urushiol, a substance that can cause a skin reaction in about 60–80 percent of people who come in contact with it. The reaction can appear within minutes, hours, or days, and includes itchy, red, and swollen skin and blisters. After a few days, the blisters may become crusty, but usually takes 1–2 weeks to heal. Even if you haven’t been out in the woods yourself, you can pick up urushiol from anything that has come into contact with the oil, including a pet. You can try to wash the urushiol off your skin right away—a shower is better than a bath (the oil is more likely to spread to other areas through the bath water). Once the oil has been washed off, the rash is unlikely to spread, but the reaction remains.
Cold compresses, anti-itch lotion, over-the-counter hydrocortisone cream, and an antihistamine can help ease itching. Contact a doctor if the rash is near your eyes, throat, or widespread. An oral steroid or other treatment may be necessary.
10. Viral rash
Some rashes are associated with viral illnesses. Although they are often accompanied by fever or cold symptoms, there’s usually no cause for concern. Chicken Pox, Fifth Disease, Roseola, and Hand-Foot-Mouth Disease are the most common rash-causing viruses.
Fifth Disease, also known as “slapped cheek disease,” causes a rash that begins on the cheeks, making it appear as if your child has been slapped. It then spreads as pimply bumps to your child’s stomach and extremities. The rash may also be accompanied by a fever, runny nose, and cough. Other viruses that produce rashes include Roseola, which begins with several days of high fever followed by a splotchy, raised, pink rash. It starts on the chest, back, and stomach and spreads to the neck and arms. Hand-Foot-Mouth Disease (or Coxsackie) is a virus that begins with a of fever followed by blister-like sores in the mouth and/or a skin rash on the palms of the hands and soles of the feet.
With the exception of Chicken Pox, viral rashes generally are not contagious once a child has been fever-free for 24 hours, and most viral rashes will clear up on their own with little to no treatment.