Scarlet Fever (Child)

Scarlet fever is caused by infection with streptococcal bacteria. These are the same bacteria that cause strep throat. Symptoms include throat pain that starts quickly, pain while swallowing, and tonsils that are red and swollen. Sometimes there are streaks of pus, and tiny red spots on the roof of the mouth, or a painful skin infection along with a rash. The tongue may have a whitish coating. Or it may be red with small bumps (called strawberry tongue). The rash often appears a few days after the sore throat or skin infection. It looks like tiny raised pink dots with a rough feeling like sandpaper. The child may ache all over and have headache and a fever.

It's very important that the infection be treated as soon as possible. This is to prevent damage to certain organs. Antibiotics are used to treat the infection. After a few days of treatment, the child may begin to feel better. The rash often clears up after 4 to 5 days. The skin may peel (like after a sunburn) in 1 to 2 weeks.

Home care

  • Give your child the antibiotic medicines as directed until they are gone, or until the healthcare provider tells you to stop, even if your child is feeling better. This is very important to prevent later problems from strep infection (such as heart or kidney disease).

  • You may use over-the-counter medicine as directed based on your child's age and weight for fever and discomfort. Aspirin should never be used in anyone younger than age 19 who is ill with a fever. It may cause severe disease or death. If your child has chronic liver or kidney disease, or ever had a stomach ulcer or gastrointestinal bleeding, talk with your child's healthcare provider before using these medicines.

  • Fever increases water loss from the body:

    • For infants younger than 1 year:  Continue regular feedings (breast or formula). Between feedings, give plain oral rehydration solutions. You can buy these at food stores and drugstores without a prescription. Ask your pharmacist for a recommendation.

    • For children 1 year or older:  Give plenty of fluids like water, juice, gelatin, lemonade, or popsicles.

  • It is OK if your child doesn't want to eat solid foods for a few days, as long as they drink plenty of fluids.

  • Ask your child's healthcare provider before giving any over-the-counter medicines. Never give your child adult medicines.

  • Keep your child home from daycare or school until they've finished at least 24 hours of antibiotics and are feeling better.

  • Give older children throat lozenges if needed to help reduce throat pain. Gargling with warm saltwater may also help. (Dissolve 1/2 teaspoon of salt in 1 glass of hot water.)

Follow-up care

Follow up with the child's healthcare provider, or as advised. 

Call 911

Call 911 if any of these occur:

  • Throat pain causing severe drooling, inability to swallow, or inability to open mouth wide

  • Trouble breathing

  • Abnormal drowsiness or confusion

When to get medical advice

Call your child's healthcare provider right away if any of these occur:

  • Fever (see "Fever and children" below)

  • Fussiness or crying that can't be soothed

  • Throat pain or headache that's getting worse

  • Neck pain or stiffness

  • Dark purple rash

  • Blood in the urine

  • Joint pain or swelling

  • Not peeing as often

  • Decreased level of activity

  • Sleeping too much

  • Concern for fluid loss (dehydration)

  • Symptoms get worse or new symptoms occur

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 they are 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 them 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° (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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