Scarlet Fever in Children

Scarlet fever, a disease that once struck fear into the hearts of parents, is a bacterial infection that predominantly affects children. Although it was once considered severe and often fatal, advancements in medicine have transformed it into a treatable condition. This comprehensive guide aims to provide you with everything you need to know about scarlet fever in children.

Scarlet fever is caused by the same bacteria responsible for strep throat, Streptococcus pyogenes. The bacteria release toxins that lead to the characteristic red rash from which the disease derives its name. The rash, which feels like sandpaper to the touch, typically starts on the neck and face before spreading to the rest of the body.

Children between the ages of 5 and 15 are most susceptible to scarlet fever, with a peak incidence in those aged 4 to 8. It’s a highly contagious disease, spreading through respiratory droplets when an infected person coughs or sneezes. It can also spread through shared utensils, bed linen, clothes, and other household items.

Symptoms of scarlet fever include a sore throat, high temperature, flushed face, and a swollen tongue. The distinctive red rash usually appears a day or two after these initial symptoms. It’s essential to seek medical attention if your child exhibits these symptoms, as untreated scarlet fever can lead to serious complications such as rheumatic fever and kidney disease.

Fortunately, scarlet fever responds well to antibiotics, which can alleviate symptoms, reduce the duration of the illness, and minimize the risk of complications. Alongside medical treatment, rest, hydration, and over-the-counter remedies can help manage symptoms and ensure a smooth recovery.

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Understanding scarlet fever, its symptoms, treatment options, and preventative measures can equip parents with the knowledge to handle this childhood illness effectively. As we delve deeper into this guide, we’ll explore each of these aspects in detail, providing a comprehensive resource for parents and caregivers navigating the challenges of scarlet fever in children.

Understanding Scarlet Fever In Children

Scarlet fever, once a common and severe childhood disease, has become less threatening today. However, it remains a condition that parents and caregivers should be informed about to ensure timely recognition and treatment. Understanding what scarlet fever is, its causes, and how it manifests is crucial in managing the illness effectively.

What is Scarlet Fever?

Scarlet fever is an infectious disease that primarily affects children between the ages of 5 and 15, though it can occur at any age. It is characterized by a distinctive red rash, high fever, and a sore throat. The disease is caused by a strain of bacteria known as Streptococcus pyogenes, or group A streptococcus, which is the same bacterium responsible for strep throat. When this bacterium produces a particular toxin, an individual exposed to it may develop a rash that is characteristic of scarlet fever.

Understanding Scarlet Fever In Children

Distinguishing Scarlet Fever from Other Childhood Illnesses

Scarlet fever is often confused with other childhood diseases that present with similar symptoms, such as measles or a fifth disease. However, several features distinguish scarlet fever:

  • Rash: The rash in scarlet fever is fine, red, and feels like sandpaper. It typically starts on the chest and stomach before spreading to other parts of the body.
  • Strawberry Tongue: Early in the infection, the tongue may be coated, or white, developing a red, swollen appearance a few days later.
  • Fever and Sore Throat: These symptoms are similar to those of strep throat, but the presence of the rash is a key differentiator.

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Understanding these distinctions is vital for parents and caregivers to seek appropriate medical attention, as treatments for these conditions can differ significantly.

How Scarlet Fever Differs Today

Historically, scarlet fever was considered a serious childhood disease, with significant morbidity and mortality rates. However, with the advent of antibiotics, the severity and frequency of complications have dramatically decreased. Today, while still infectious and potentially serious if untreated, scarlet fever can usually be managed effectively with antibiotics, and most children make a full recovery without long-term effects.

Understanding scarlet fever involves recognizing its symptoms, knowing how it is caused, and distinguishing it from other illnesses. With this knowledge, parents and caregivers can ensure that children receive prompt and effective treatment, minimizing the risk of complications and contributing to the overall management of this once-feared disease.

Causes of Scarlet Fever In Children

Scarlet fever is a bacterial infection primarily caused by Group A streptococcal bacteria (GABHS). This bacterium releases a toxin that triggers the characteristic symptoms, including the red rash and other manifestations.

Symptoms of Scarlet Fever in Children

  1. Sore Throat: Scarlet fever often begins with a sore throat, which can be quite painful for the child.
  2. High Fever: Children with scarlet fever may experience a high fever, typically ranging from 101°F to 104°F (38.2°C to 40°C).
  3. Headache: Headaches are common during the initial stages of scarlet fever.
  4. Red Rash: Within 24 hours of the initial symptoms, a characteristic red rash appears. The rash starts on the chest and tummy, then spreads to the arms and legs. It feels rough, like sandpaper, and looks pink or red on white skin. On brown and black skin, it might be harder to see a color change, but the raised bumps are still noticeable.
  5. Strawberry Tongue: Children with scarlet fever often develop a white coating on their tongue, which later peels off, leaving the tongue red, swollen, and covered in little bumps. This appearance is sometimes referred to as “strawberry tongue.”
  6. Flushed Face: The child’s face may appear flushed.
  7. Enlarged Lymph Nodes: Tender and enlarged lymph nodes in the neck are common.
  8. Other Symptoms: Additional symptoms may include nausea, vomiting, and difficulty swallowing.

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Remember that scarlet fever is highly contagious, so it’s essential to seek medical attention if your child exhibits these symptoms. A GP can diagnose scarlet fever by examining the tongue and rash. Additionally, keep the child away from others until 24 hours after starting antibiotics to prevent further spread of the infection.

Symptoms of Scarlet Fever in Children

How Scarlet Fever is Spread

Let’s delve into how this contagious illness spreads::

  1. Respiratory Droplets: Group A strep bacteria primarily reside in the nose and throat. Infected individuals spread the bacteria through:
    • Talking, coughing, or sneezing, releases respiratory droplets containing the bacteria.
    • Inhaling these droplets or touching surfaces contaminated with them and then touching the mouth or nose.
  2. Direct Contact: People can also transmit group A strep bacteria through infected skin sores (such as impetigo). Touching the sores or coming into contact with fluid from the sores can lead to transmission.

Remember, early diagnosis and proper treatment are crucial for managing scarlet fever and preventing its spread to others. 

For more information, you can refer to the CDC’s Scarlet Fever page.

Complications of Scarlet Fever in Children

If left untreated, scarlet fever can lead to several complications:

  1. Rheumatic fever: An inflammatory condition affecting the heart, joints, and other organs.
  2. Kidney disease: Scarlatinal nephritis, which can cause kidney damage.
  3. Ear infections: Otitis media due to the spread of bacteria.
  4. Skin infections: Such as impetigo.
  5. Throat abscesses: Collection of pus in the throat.
  6. Pneumonia: Infection of the lungs.
  7. Arthritis: Joint inflammation.

Early diagnosis and prompt treatment are crucial to prevent complications and protect others from infection.

How Scarlet Fever is Diagnosed in Children

The diagnosis of scarlet fever involves the following steps:

  1. Physical Examination: The child’s throat, tonsils, and tongue are checked for texture and appearance of the rash along with enlargement of lymph nodes.
  2. Throat Culture: A swab from the tonsil or deep throat is tested by culturing or PCR for strep bacteria.
  3. Rapid Antigen Test: This is a faster but less reliable method to check for Group A Streptococcus bacteria.

These tests are crucial because several conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.

Treatment Options for Scarlet Fever in Children

Here’s a concise overview of treatment options for scarlet fever in children:

  1. Antibiotics: Scarlet fever is typically treated with antibiotics. The following antibiotics are commonly used:
    • Penicillin: This is the preferred choice and is usually given orally for a 10-day course.
    • Amoxicillin: Similar to penicillin, it’s effective against streptococcal bacteria.
    • Erythromycin: An alternative antibiotic for those allergic to penicillin.
  2. Fever and Pain Management: Use ibuprofen (Advil, Children’s Motrin) or acetaminophen (Tylenol) to control fever and minimize throat pain. Always check with your child’s healthcare provider for the correct dosage.
  3. Self-Care Measures:
    • Rest: Ensure your child gets plenty of rest to aid in fighting the infection.
    • Hydration: Encourage your child to drink plenty of water to keep the throat moist and prevent dehydration.
    • Saltwater Gargle: For older children and adults, gargling with warm saline (saltwater) can help relieve throat pain.
    • Humidify the Air: Use a cool-mist humidifier to ease discomfort.
    • Honey: Soothe sore throats with honey (not recommended for children under 12 months).
    • Soft Foods: Offer easy-to-swallow foods like soups, applesauce, mashed potatoes, and yogurt.

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Remember to complete the full course of antibiotics even if your child starts feeling better. Once your child has taken antibiotics for at least 12 hours and is fever-free, they can return to school. If you have any concerns, consult your healthcare provider. 

Prevention of Scarlet Fever in Children

Prevention of Scarlet Fever in Children

Here are some important measures for preventing scarlet fever in children:

  1. Hand Hygiene: Regularly wash hands with warm water and soap. Proper hand hygiene helps prevent the spread of group A streptococcus bacteria, which cause scarlet fever.
  2. Avoid Sharing Personal Items: Encourage children not to share eating utensils, linens, towels, or other personal items. This minimizes the risk of bacterial transmission.
  3. Stay Home When Sick: If a child has strep throat or scarlet fever, they should stay away from school or daycare for at least 24 hours after starting antibiotics. This prevents the spread of infection to others.

Remember, there is currently no vaccine to prevent strep throat or scarlet fever, so practicing good hygiene and being vigilant about symptoms are essential for prevention. 

When to Return to School or Daycare

After a child has been diagnosed with scarlet fever, one of the primary concerns for parents and caregivers is determining the right time for them to return to school or daycare. The key factors to consider include the child’s health, the potential risk of transmitting the infection to others, and public health guidelines. Here’s a detailed breakdown to help make this decision more straightforward:

1. Understanding the Contagious Period

Scarlet fever is contagious from up to 2-3 days before the onset of symptoms until 24 hours after starting appropriate antibiotic treatment. Without treatment, individuals can remain infectious for 2 to 3 weeks after symptoms appear. Understanding this timeline is crucial in making informed decisions about returning to communal settings.

2. Guidelines for Returning

  • After Starting Antibiotics: The general guideline is that children can return to school or daycare 24 hours after beginning antibiotic treatment, provided there is a noticeable improvement in their symptoms, especially the fever. This guideline is based on the significant reduction in contagion after antibiotics are initiated.
  • Symptom Improvement: Aside from being on antibiotics for 24 hours, ensure that the child feels well enough to participate in activities and that the fever has resolved. A child who is still feeling very unwell, fatigued, or has a persistent fever should remain at home regardless of the 24-hour rule.
  • Doctor’s Advice: Always follow the advice of your child’s healthcare provider regarding when it is safe to return to school or daycare. Doctors might recommend a longer period at home for children who are more susceptible to complications or in cases where the infection is particularly severe.

3. Preventing the Spread

Upon returning to school or daycare, it’s important to continue taking steps to prevent the spread of infection. These include:

4. Good Hygiene Practices

Teach your child the importance of regular handwashing, especially before eating and after using the bathroom. Using hand sanitizer can be an alternative if soap and water are not readily available.

5. Respiratory Etiquette

Encourage your child to cover their mouth and nose with a tissue or their elbow when coughing or sneezing and to avoid close contact with others who are ill.

6. Personal Items

Remind your child not to share personal items, such as water bottles, utensils, and towels, with classmates.

7. Communication with the School or Daycare

Before your child returns, communicate with the school or daycare about the diagnosis, treatment, and clearance to return. This transparency allows the institution to monitor for potential new cases and reinforces the importance of infection control measures among all students and staff.

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In summary, deciding when a child should return to school or daycare after scarlet fever involves balancing the need to prevent the spread of infection with the child’s right to education and social interaction.

By adhering to public health guidelines, ensuring the child is on antibiotics for at least 24 hours and symptom improvement, and maintaining good communication with educational institutions, parents and caregivers can navigate this decision confidently.

Myths vs. Facts on Scarlet Fever

Scarlet fever, like many illnesses, is surrounded by misconceptions that can lead to unnecessary alarm or, conversely, to complacency. Dispelling these myths with factual information is crucial for proper understanding and management of the disease. Here are some common myths about scarlet fever, accompanied by the facts to set the record straight.

Myth 1: Scarlet Fever is Extremely Contagious

Fact: While scarlet fever can be spread through close contact and respiratory droplets, its contagiousness is often overstated. The bacterium that causes scarlet fever, Streptococcus pyogenes, requires prolonged or close contact for transmission. Proper hygiene practices, such as frequent handwashing and covering the mouth when coughing or sneezing, can significantly reduce the risk of spread.

Myth 2: Scarlet Fever is a Disease of the Past

Fact: Many people believe that scarlet fever is a relic of the past, eradicated or no longer a concern due to modern medicine. While it’s true that the incidence of scarlet fever has decreased dramatically, especially in developed countries, outbreaks still occur. It remains a public health issue, underscoring the importance of awareness and timely treatment.

Myth 3: Only Children Can Get Scarlet Fever

Fact: Although scarlet fever most commonly affects children aged 5 to 15, it can occur in people of any age. Adults, especially those who work closely with children or live in crowded conditions, are also at risk of contracting the disease. Recognizing the symptoms regardless of age is important for seeking prompt treatment.

Myth 4: Scarlet Fever Always Causes a High Fever

Fact: While fever is a common symptom of scarlet fever, its severity can vary from one person to another. Some individuals may experience only a mild fever. The presence of other symptoms, such as a sore throat, the characteristic rash, and a “strawberry tongue,” are also key indicators of the disease.

Myth 5: Antibiotics are Not Necessary for Treating Scarlet Fever

Fact: Antibiotics are crucial in the treatment of scarlet fever. They not only help to alleviate symptoms more quickly but also prevent the development of complications and reduce the contagious period. Failing to complete the prescribed course of antibiotics can lead to a resurgence of the infection and contribute to antibiotic resistance.

Myth 6: Once You’ve Had Scarlet Fever, You’re Immune for Life

Fact: While it is less common to contract scarlet fever multiple times, it is not impossible. The bacteria that cause scarlet fever can produce different strains of toxins, meaning that previous infection with one strain does not provide immunity against all others. Reinfection can occur, particularly if the individual is exposed to a different strain of the bacteria.

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Understanding the facts about scarlet fever can help parents, caregivers, and the general public navigate concerns about this disease more effectively. Dispelling myths is crucial in ensuring that those affected seek appropriate care and take necessary precautions to prevent its spread. Awareness and education are key components in the management and control of scarlet fever.

Supporting Your Child Through Recovery

Supporting Your Child Through Recovery

Recovering from scarlet fever is a process that extends beyond the physical symptoms. It encompasses emotional support, monitoring for potential complications, and ensuring a comfortable environment for healing. Here’s how caregivers can comprehensively support their child through the recovery phase of scarlet fever.

1. Providing Physical Comfort

  • Manage Fever and Pain: Use children’s acetaminophen or ibuprofen (as advised by your pediatrician) to manage fever and throat pain. Remember, aspirin should be avoided in children due to the risk of Reye’s syndrome.
  • Ensure Adequate Hydration: Encourage your child to drink plenty of fluids. Water, soups, and ice pops can help keep them hydrated and soothe a sore throat.
  • Soft Foods: Offer soft, easy-to-swallow foods like applesauce, yogurt, and mashed potatoes if your child has difficulty swallowing.

2. Emotional Support

  • Reassurance: Scarlet fever can be frightening for a child. Offer reassurance that what they’re experiencing is temporary and that they’re on their way to feeling better.
  • Comfort and Presence: Spend extra time with your child, reading to them, playing quiet games, or simply being present. Your proximity can provide a significant source of comfort.
  • Understanding and Patience: Recognize that your child may be more irritable or emotional during this time. Offer a listening ear and respond with patience and understanding.

3. Monitoring for Complications

  • Watch for Signs of Worsening: While rare, complications can arise from scarlet fever. Be vigilant for any signs of worsening symptoms, such as increased fever, difficulty breathing, swelling in the neck, or persistent vomiting, and seek medical attention if these occur
  • Follow-up Appointments: Attend any recommended follow-up appointments with your child’s healthcare provider to ensure the infection is fully resolved and to address any complications early.

 4. Creating a Healing Environment

  • Rest: Ensure your child gets plenty of rest. Their body needs energy to fight off the infection and heal.
  • Hygienic Practices: Maintain a clean environment. Regularly wash your child’s bedding, dishes, and toys to prevent the spread of bacteria.
  • Isolation: Keep your child home from school or daycare as recommended. This not only aids in their recovery but also prevents the spread of the infection to others.

5. Long-term Outlook

  • Reassurance About Recovery: Most children recover completely from scarlet fever with appropriate treatment. Reassure your child (and yourself) that with time, they will feel back to normal.
  • Awareness of Recurrence: Although rare, it’s possible for scarlet fever to recur. Educate your child on the importance of handwashing and general hygiene to reduce their risk of reinfection.

Supporting your child through the recovery process of scarlet fever involves more than just addressing the physical symptoms; it requires emotional support, vigilance for complications, and creating a nurturing environment for healing.

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With comprehensive care, most children recover completely, with their daily routines soon returning to normal. As always, maintain open communication with your healthcare provider throughout your child’s recovery to ensure the best possible outcomes.


Scarlet Fever is a bacterial illness that primarily affects children, particularly those between the ages of 5 and 15. It is caused by Group A streptococcal bacteria and is characterized by symptoms such as high fever, sore throat, red rashes, and a “strawberry” tongue. The disease is highly contagious and can be spread through respiratory droplets or direct contact.

However, it can be effectively treated with antibiotics, which not only help the patient recover faster but prevent the spread of the infection. Despite the potential severity of the illness, with prompt and appropriate treatment, long-term health problems are not common. Therefore, parents and caregivers must be aware of the symptoms of Scarlet Fever and seek immediate medical attention if the child exhibits these symptoms. This will ensure a swift diagnosis and treatment, thereby minimizing the risk of complications.

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