Fever and Rash in Children
By Dr. Khoo Phaik Choo
Consultant Paediatrician
MBBS (Malaya), LRCP, MRCS (London), DCH (United Kingdom),MRCP (United Kingdom)
Sime Darby Medical Centre
Help! My nine-month-old boy has developed a fever and also some red spots. Is this dangerous?
Generally speaking, fever and rashes occur fairly commonly in babies and young children. One of the most common infections is called Roseola which is prevalent in babies aged between six months and two years.
What are the symptoms of Roseola?
The first symptoms include:
- A sudden fever of 38°C to 41°C
- Occasional runny nose and cough
- Commonly mild diarrhoea
- Loss of appetite, irritability and listlessness
However, the tell-tale sign of Roseola is the appearance of a pinkish-red, spotty rash, following the disappearance of a high fever which might have lasted three to four days.
The rash will usually appear on the baby’s tummy and chest, before spreading to other parts of the body. It will fade in approximately two days. The rash is generally not itchy.
What do I do if my baby has Roseola?
There is no specific treatment for Roseola, as it is caused by a virus called Human Herpes Virus Type 6 (HHV-6). It will run its course until your baby feels better.
In the meantime, some of the things you can do to make him feel comfortable are:
- Do not force-feed him or fret about food refusal as the baby will most likely lose his appetite.
- Encourage fluids to prevent dehydration and also compensate for fluid losses caused by the diarrhoea.
- You can give your baby infant paracetamol to ease his fever and discomfort.
- Tepid baths and sponging will also help the fever.
Are there any complications associated with Roseola?
The high fever associated with Roseola can sometimes cause a febrile convulsion, which usually does not cause any harm but may be frightening for the care-givers!
Doctor, what is “false measles”?
Well, this term usually includes a whole range of fevers associated with rashes and which are not diagnosed as the “real thing” (measles/rubeola/morbilli).
Is having measles common?
With the introduction of the MMR vaccine (measles/mumps/rubella) into the immunisation schedule, measles is less commonly seen nowadays.
How is it recognizable?
The initial symptoms of measles appear around 10 days after measles infection, and generally lasts for up to 14 days. The symptoms include:
- Cold-like symptoms, such as runny nose, cough, watery eyes and sneezing.
- Red eyes and sensitivity to light.
- A moderate to severe temperature for several days.
- Tiny greyish white spots (called kopliks spots) in the mouth and throat.
- Lethargy and poor appetite.
- A red brown spotty rash which appears two to four days after initial symptoms and can last from eight to 10 days. The rash usually starts behind the ears, and gradually spreads to the face and then downwards to the rest of the body. It is usually itchy.
The complications caused by measles can be quite nasty. What are they?
Whilst the vast majority of patients survive measles, complications include bronchitis, ear infections (otitis media) and panencephalitis (brain infection) which is potentially fatal.
My three-year-old toddler’s play school was recently closed for one week because of an outbreak of hand-foot-mouth (HFM) disease. What is this?
HFM disease is a common viral illness that usually affects infants and children below five years old. However, it can sometimes occur in adults and older children as well. The disease is highly contagious.
What are the signs and symptoms?
HFM disease usually starts with a fever, poor appetite and sore throat. One or two days after the fever starts, painful sores usually develop in the mouth, often at the back, which makes swallowing painful. A skin rash may develop over one or two days. The rash typically looks like a blister, and is usually seen on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.
Can my child be vaccinated against this disease?
Unfortunately, there is no vaccine to protect against the viruses that cause HFM disease. Good hygiene practices, such as washing of hands with soap and water, especially after changing diapers and using the toilet, is important. As there is no specific treatment for HFM disease, you can relieve your child’s symptoms by giving him analgesic to ease the pain and to enable him to drink. If he cannot swallow enough liquids, he may need an intravenous infusion at the hospital. HFM disease is usually self-limited, and your child should get better after four to five days. However, uncommon complications can occur, and they include meningitis or encephalitis (brain inflammation). These cause fever, headache, vomiting and stiff neck. The child is generally very ill at this point.
My neighbour’s child was recently admitted for dengue fever and she stayed in hospital for a week. It sounded serious. Can you tell me more about it?
In a tropical country such as ours where mosquitoes abound, a disease like dengue fever is endemic. There are four types of dengue virus and infection; one dengue type does not confer protection against the other three types.
Oh dear, does this mean we can suffer from more than one episode of dengue fever?
Yes, although not all attacks are severe. The more serious attacks are called dengue haemorrhagic fever, which can be life-threatening. The virus is transmitted from the bite of an infected mosquito, usually the Aedes mosquito. It is therefore so important to continually prevent or minimize formation of stagnant pools in the house as well as empty water containers so these mosquitoes will not breed.
Does dengue fever commonly occur with rash?
Not always, but it is common. It does not usually appear at the beginning of fever, but a few days later. The rash can become very red (flushing of the skin) and is generally very itchy.
Do patients diagnosed with dengue fever need to be admitted to the hospital?
No, as previously mentioned not all dengue attacks are severe. Your doctor should be able to guide you. Blood counts and the clinical status are considered.
