Scarlet fever

Symptoms

• Fever of 38.3^oC (101^oF) or higher
• Severe sore throat that makes swallowing difficult
• Stomach ache
• Nausea and occasional vomiting
• Reddish rash with small bumps
• Whitish coating on the tongue; when the white fades, the tongue turns bright red

The rash first appears on the neck and in the skin folds (under the arms, at the elbows, and on the thighs) within 24 to 48 hours after the first symptoms. It can spread to the rest of the body in 2 or 3 days. The rash gives the skin a sandpaper-like texture.

• Inability to eat or drink and infrequent urination
• Trouble opening their mouth
• Excessive drooling
• Severe ear or head pain
• Seizures
• A temperature over 40°C (104°F)

What is scarlet fever?

Scarlet fever is an infection caused by a bacteria called streptococcus. This bacteria produces toxins that cause a rash. Scarlet fever is contagious.

Because there are different types of streptococcal bacteria and the toxins they produce, a person can have scarlet fever more than once in their lifetime. The streptococcus that causes scarlet fever can also infect adults, but it usually causes only a throat infection. Scarlet fever with rash is rare in adults.

In rare cases, the rash may occur without a sore throat coming first. If so, the infection is caused by a different type of bacteria, such as staphylococcus.

If left untreated, scarlet fever can lead to rare complications that affect the ears, kidneys, liver, heart, brain, and joints. It can also cause abscesses at the back of the throat. For that reason, it is very important to see a doctor if you suspect your child has scarlet fever.

Treatment

An antibiotic treatment (in liquid or pill form) can help shorten the duration of the illness and prevent complications and the spread of infection.

It’s very important to complete the full course of the prescribed medication, even if symptoms have subsided. Stopping early can lead to a relapse, cause complications, and lead to antibiotic resistance.

Care and practical advice

• Encourage quiet activities. Your child doesn’t need to stay in bed all day, but they should get plenty of rest.
• Give them lots of fluids: water, soup, juice, etc. Avoid juices that are too acidic (e.g., orange juice, lemonade), as they can make a sore throat worse. If your child is having trouble drinking, try making popsicles with grape, pear, or apple juice.
• Give them soft foods (purees, yogurt, ice cream, etc.) in small portions, 5 or 6 times a day. You can also give them soup: Chicken noodle soup is especially good.
• Have your child gargle a few times a day with a solution of 2.5 ml (½ tsp) of salt dissolved in a glass of warm water.
• To relieve pain and fever, give them acetaminophen (Tylenol^®, Tempra^®) or ibuprofen (Advil^®, Motrin^®) following the recommended dose for their age and weight. Don’t give ibuprofen to babies under 6 months, and never give Aspirin^® (acetylsalicylic acid) to a child or teenager.
• To relieve itching, you can give your child a long-acting antihistamine such as Claritin^®.

Prevention

You can’t completely prevent scarlet fever, but you can lower the risk of spreading it by following basic hygiene measures.

• Wash your hands with soap if you’ve been in contact with someone who is infected or touched objects they’ve handled. Wash your child’s hands often, and teach them to do it themselves as soon as they’re able—especially after coughing, sneezing, or blowing their nose.
• Teach your child to cough or sneeze into a tissue. Show them how to use the crook of their elbow instead of their hands when they don’t have a tissue.
• Clean and disinfect toys, faucets, and door handles, ideally with an alcohol-based cleaner.
• Set aside dishes, glasses, and cutlery that will only be used by your child until 24 hours after they’ve started antibiotic treatment.

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and copywriting:The Naître et grandir team Updated: April 2023

Photos: iStock.com/blackjake and GettyImages/parinyabinsuk