Ilt

Does your child have red eyes, a runny nose, and/or a dry cough?

Possible cause and action Rubella, also known as German measles, is a possibility, especially if your child has swollen glands. You do not need to consult a doctor unless your child has been in contact with a pregnant woman, in which case, the diagnosis should be confirmed. Take steps to reduce your child's fever (see Bringing down a fever, p.77).

see your doctor within 24 hours possible cause Scarlet fever, a bacterial throat infection, is a likely cause of these symptoms, especially if your child is also vomiting and has a rash that is particularly prominent in the folds of the skin, such as the armpits.

action Your doctor will examine your child to confirm the diagnosis. He or she may prescribe antibiotics. Follow the advice for reducing a fever (p.77) and also for relieving a sore throat (p.107).

see your doctor within 24 hours possible cause Measles is the most likely cause of these symptoms, even if your child has been immunized against the disease.

action Your doctor will examine your child to confirm the diagnosis. He or she may prescribe antibiotics. Make sure your child drinks plenty of fluids (see Encouraging your child to drink, p.67), and follow the advice for bringing down a fever (p.77).

Continued from previous page

Does your child have a bright red rash on the cheeks with or without a lacy rash on the trunk?

no yes

Is your child under 2 years old, and did he or she have a high fever for 3-4 days before a rash developed on his or her body.

Is your child under 6 years old, and does he or she have any of the following?

• Swollen hands and feet

• Dry, cracked and swollen lips

• Swollen glands no

Has your child taken any new drugs within the last week?

yes no

Viral infections that cause a rash

Many viral infections cause a fever and a rash. The more serious ones, such as measles, have become much less common as a result of routine immunizations. Many of these infections can also affect adults, whose symptoms can be more severe than children's. The incubation period is the time between acquiring an infection and first developing symptoms.

Disease (incubation period)

Symptoms

Period when infectious

Chickenpox (7-21 days)

Crops of raised, red, itchy spots that turn into blisters and then scabs, mainly on face and trunk

From 2 days before the rash develops until all the blisters have scabs

Erythema infectiosum (4-20 days)

Bright red cheeks; lacy rash, mainly on trunk

Until 1 week after the rash develops

Hand, foot, and mouth disease (4 days)

Mild fever; rash of small blisters on hands, feet, and inside of mouth

For duration of blisters

Measles (7-14 days)

Cough; runny nose; red eyes; mottled or blotchy red rash, first on the face, then trunk and arms

Until 5 days after the rash develops

Roseola infantum (variable)

High fever followed by flat, lightred rash on the trunk; swollen glands in the neck

Until 5 days after the onset of the symptoms

Rubella (14-19 days)

Mild fever; swollen glands in the neck; flat pink mottled or blotchy rash, mainly on face and trunk

From 1 week before the rash develops until 5 days after the rash develops or until the rash disappears

Scarlet fever (2-5 days)

High fever; severe sore throat; vomiting; red rash on body, most obvious in skin folds

Until the prescribed course of antibiotics is completed

See your doctor within 24 hours if you are unable to make a diagnosis from this chart.

Possible cause and action Your child may have roseola infantum, a common early childhood infection. This condition is difficult to diagnose before the rash appears as the fever is the only symptom. By the time the rash appears, the child is usually better. If you suspect your child has this condition and he or she still has a fever, consult your doctor. He or she will examine your child and may do tests to exclude more serious problems.

call your doctor now possible cause Kawasaki disease, a rare condition of unknown cause, which can damage the heart and joints, is a possibility.

action If your doctor suspects that your child has Kawasaki disease, your child will be admitted to hospital, where his or her condition can be monitored and treatment given to reduce the risk of heart complications.

call your doctor now

Possible causes Your child may have an allergy to the prescribed medicine, or he or she may have a viral illness unrelated to the drug.

action Your doctor will examine your child to determine the cause of the symptoms. If your child does have a drug allergy, your doctor will be able to tell you whether your child should avoid this drug in future.

Possible cause and action Your child may have erythema infectiosum, also known as slapped-cheek disease or fifth disease. This viral condition is usually mild. Follow the advice on reducing a fever (p.77). The diagnosis should be confirmed by your doctor if your child has been in contact with a pregnant woman. If your are worried or if your child is no better in 48 hours, call your doctor.

Checking a red rash

If you or your child develops dark red or purple blotches, check whether they fade on pressure by pressing a clear glass against them. If the rash is visible through the glass, it may be a form of purpura, which is caused by bleeding under the skin and may occur in meningitis. If you or your child has a nonfading rash, call an ambulance.

Checking a rash

Here, the rash is still visible when the glass is pressed against the skin - a sign that it may be caused by an illness such as meningitis.

Skin problems in children

For skin problems in children under 1, see chart 8, Skin problems in babies (p.64).

Childhood spots and rashes are usually due to irritation or inflammation of the skin as a result of a local problem such as an allergic reaction. However, a rash associated with a fever may be due to a generalized infection (see Viral infections that cause A rash, p.79). A rash without a fever or a feeling of being unwell is probably no cause for concern; but, if it is itchy or sore, consult your doctor. Call an ambulance if a rash is accompanied by difficulty breathing and/or facial swelling.

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