Roseola

What is roseola? 

Known best for its spotty pink rash, roseola is a contagious viral illness seen most often in children under the age of 2. It’s caused by two strains of the Human Herpes Virus, HHV6 and HHV7. Parents can take comfort in knowing that this common childhood infection is rarely serious. In fact, roseola is so common that most children have a bout with it by the time they start kindergarten. Though rashes in general are a fairly common childhood occurrence, the key to a roseola diagnosis is that the rash sets in after the fever breaks. Learn more about other common childhood rashes here.) 

What are roseola symptoms? 

Although the pink rash is roseola’s signature symptom, it is typically preceded by a sudden, high fever. According to the American Academy of Pediatrics (AAP), fever associated with roseola usually ranges from 102–105° F, and lasts three to seven days. During this time, children may also experience any of the following symptoms: runny nose, sore throat, cough, fatigue, irritability, mild diarrhea, decreased appetite, swollen eyelids, and enlarged lymph nodes in the neck. 

As the fever subsides and parents begin to think their child is on the mend, the pink rash moves in, beginning on the child’s chest, back, and stomach, and spreading to his neck and arms. The rash consists of many pink spots or patches, and though the spots are generally flat, some may be bumpy and/or have a white ring around them. The rash, which can last from several hours to several days, isn’t itchy or uncomfortable—just an eyesore. It’s important to note that some children with roseola never have symptoms.

How do children get roseola? 

Like the common cold, roseola spreads through contact with respiratory secretions or saliva from an infected person. If a child is exposed to roseola, he may not display symptoms for a week or two. Children who have roseola are contagious until they’ve been fever-free for 24 hours. At that point, even if the rash remains, they can return to day care or school.

How is roseola treated? 

Because roseola is a viral illness, antibiotics will not cure it or make your child feel better. The virus must simply run its course and should do so within a week after your child’s fever begins. Your child’s health care provider may recommend acetaminophen or ibuprofen (over-the-counter medications) for fever relief. A lukewarm sponge bath or cool washcloth may also make your child more comfortable when he has a fever. As the body’s temperature increases, so does its demand for fluid. Children should drink plenty of liquids such as breast milk, water, or clear broth to prevent dehydration. Consult your child's health care provider about what fluids are best for your child's age group. There is no treatment for the rash itself and parents should not apply any lotion to the affected areas.

How can roseola be prevented? 

There isn’t a vaccine for roseola, so frequent handwashing is the key to avoiding it and other contagious viruses. Children infected with roseola develop antibodies to the illness and probably won’t get it again. An adult who never had roseola as a child can contract it but symptoms are typically mild.

When should I call the doctor? 

Fevers are generally harmless and indicate that your child’s body is fighting an infection. Fever associated with roseola is no different, but to be on the safe side, parents should contact their child’s health care provider in the following cases: 

  • Child is younger than 12 weeks old with a fever of 100.4° F (38.0°C) or higher
  • Child is 3 weeks to 2 years old with a fever of 102° F (38.9°C) or higher
  • Child is age 2 or older with a fever of 103° F (39.4°C) or higher
  • Fever rises above 104°F (40°C) repeatedly for a child of any age
  • The fever persists for more than 24 hours in a child younger than 2 years old
  • The fever persists for more than 3 days ( 72 hours) in a child 2 years of age or older
  • Looks very ill, is unusually drowsy, or is very fussy
  • Has other symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
  • Has signs of dehydration, such as a dry mouth, sunken soft spot or significantly fewer wet diapers and is not able to take in fluids
  • Has immune system problems, such as sickle cell disease or cancer, or is taking steroids
  • Has had a seizure

In rare cases, a child with roseola will experience a febrile seizure due to the rapid rise in body temperature. During this common childhood seizure, the child may lose consciousness for a brief period of time and jerk his arms, legs, or head for up to five minutes. If this happens, the AAP advises parents to take the following actions: 

  • Place her on the floor or bed away from any hard or sharp objects.
  • Turn her head to the side so that any saliva or vomit can drain from her mouth.
  • Do not put anything into her mouth; she will not swallow her tongue.
  • Call your child's doctor.
  • If the seizure does not stop after 5 minutes, call 911 or your local emergency number.

Though fever-related seizures in healthy children generally aren’t serious and do not cause long-term harm, parents should contact their child’s pediatrician if such a seizure occurs. In addition, contact a health care provider if your child’s fever or rash lasts for more than a few days.

Last updated May 9, 2018

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