Fifth Disease

Fifth disease (erythema infectiosum) is generally a mild illness caused by a virus called parvovirus B19. It most often affects children during the late winter and early spring. The name "fifth disease" comes from it being the fifth childhood disease classified—after measles, mumps, rubella, and chickenpox. Like those diseases, there is a rash.


It takes 4 to 14 days after a child is infected to show symptoms. This time is also when children are the most contagious. A rash appears 2 to 3 weeks after your child is infected. When the rash appears, your child can no longer give the illness to another child. This also means that children spread the disease before anyone knows they have it.

Fifth disease usually starts with symptoms of a mild cold or flu-like illness:

  • Low-grade fever

  • Muscle aches

  • Runny nose

  • Headache

  • Sore throat

  • Tiredness

  • Joint pains

Several days later, a rash develops. This is a splotchy red facial rash that looks like your child has been slapped. In fact, many people used to call it "slapped cheek" disease because of this look. The rash then spreads to the rest of the body.

The virus spreads by coughing and sneezing or by sharing glasses and utensils.

Most children with fifth disease fully recover without any problem. Complications may occur in people with weak immune systems and those with sickle cell disease. Pregnant women who are exposed to this illness should talk with their healthcare providers. About half of pregnant women are immune to parvovirus 19. Women who are not immune and get fifth disease during pregnancy have a rare risk for miscarriage. Miscarriage usually happens during the first half of their pregnancy. A blood test can be done to see if you are immune or have had a recent infection.

Home care

Man giving boy glass of water.

Because fifth disease is caused by a virus, antibiotics don't help get rid of it. Antibiotics don't kill viruses. Instead, the goal of treatment is to ease symptoms, as with most colds and viruses. Follow these guidelines when caring for your child at home.

  • Give your child extra fluids.

  • Encourage your child to rest until they feel better.

  • Have your child wash their hands often and throw away tissues after wiping or blowing the nose.

  • Wash your hands before and after touching your child.

  • Teach your child to cover their mouth and nose when they cough or sneeze.

  • Teach your child not to touch their eyes, nose, or mouth.

  • Keep your child home until they are well.

  • Have your child stay away from people who are ill.

  • Follow your healthcare provider's instructions for using over-the-counter pain medicine such as acetaminophen for fever, fussiness, or pain. In babies older than 6 months, you may use children's ibuprofen. Ask your healthcare provider about alternating acetaminophen and ibuprofen. Talk with the provider before giving these medicines if your child has chronic liver or kidney disease or has ever had a stomach ulcer or gastrointestinal bleeding. Never give aspirin to anyone younger than 18 years of age who is ill with a viral infection or fever. It may cause a serious illness called Reye syndrome that may result in severe liver or brain damage.

Follow-up care

Follow up with your child’s healthcare provider, or as advised.

Call 911

Call 911 if any of these occur:

  • Trouble breathing

  • Can't swallow

  • Very drowsy or trouble awakening

  • Fainting or loss of consciousness

  • Rapid heart rate

  • Seizure

  • Stiff neck

When to seek medical advice

For a usually healthy child, call the healthcare provider right away if any of these occur:

  • Fever (see Fever and children, below)

  • Your baby is fussy or cries and can't be soothed.

  • Symptoms get worse or don't start to improve after 2 days of treatment.

  • Your child shows unusual fussiness, drowsiness, or confusion.

  • Your child shows symptoms of dehydration: no urine for 8 hours, no tears when crying, sunken eyes, or dry mouth.

  • Your child has a headache, neck pain, or a stiff neck.

  • Your child experiences frequent diarrhea or vomiting.

  • Your child has ear pain or increasing throat pain that causes trouble swallowing.

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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