What causes scarlet fever?

Scarlet fever is caused by group A Streptococcus bacteria. This is the same bacteria strain that causes strep throat.

How is scarlet fever spread?

Scarlet fever can be spread in these ways:

• Breathing infected air. The germs can enter the air when an infected person coughs or sneezes.

• Contact with fluids from an infected person. This includes nasal fluids.

• Contact with items that have been used by an infected person. This includes cups, toothbrushes, or towels.

What are the symptoms of scarlet fever?

Symptoms usually appear 24 to 48 hours after exposure. These include:

• A red rash that appears most often on the chest, back, or belly (abdomen). This rash is also called sandpaper rash. This is because it raises the skin and makes it feel like sandpaper. The rash may come before other symptoms or up to a week after.

• Sore throat (strep throat)

• Fever

Other symptoms that may occur include:

• Red cheeks

• Paleness around the mouth

• Strawberry tongue (white coating and red bumps appear on the tongue, making it look like a strawberry)  

• Swollen tongue, tonsils, or glands

• Muscle aches

• Abdominal pain

• Nausea or vomiting

• Headache

As the rash fades, you may see some peeling skin. This is often around the fingers, toes, and groin area.

How is scarlet fever diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and health history. They will examine your child. If the provider thinks your child has scarlet fever, they will swab the back of your child’s throat to check for strep bacteria.

How is scarlet fever treated?

• Scarlet fever generally lasts about 7 to 10 days. The fever and sore throat usually go away within  48 to 72 hours of starting treatment. The rash may take  7 days to go away. Some peeling or flaking of the skin is normal.

• Antibiotics are prescribed by the healthcare provider. These can be given by shot (injection). Or they may be given by mouth. Make sure your child takes all of the medicine, even if they feel better.

• Your child is no longer contagious 24 hours after starting antibiotic treatment. They can go back to school or daycare when they feel well enough and they don't have a fever and have been on antibiotics at least 24 hours.

• Use children’s medicine to treat sore throat pain. Discuss all over-the-counter (OTC) products with your child’s provider before using them. Don’t give OTC cough and cold medicines to a child younger than 6 years old unless the provider tells you to do so. Never give aspirin to a child under age 18. It could cause a rare but serious condition called Reye syndrome. This condition affects the liver and brain. Never give ibuprofen to a baby age 6 months or younger.

• Anyone in the family who has similar symptoms over the next 5 days should be checked for a strep infection.

When should I call my child's healthcare provider?

Call the healthcare provider right away if your child has any of these:

• Fever (see Fever and children, below)

• Symptoms that don’t get better within 48 hours of starting treatment

• A rash that gets worse

• A lot of peeling of the skin

• Trouble swallowing

What are the long-term concerns?

Complications are rare but can occur, especially if bacteria have spread to other parts of the body. If untreated, scarlet fever can cause other serious long-term health problems. Be sure to contact your child’s healthcare provider right away if your child ever has a sore throat with a rash.

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 a 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 is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

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

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

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

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

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

• A fever of ___________ as advised by the provider