When Your Child Has Scarlet Fever

Scarlet fever is an illness that appears as a red (scarlet) rash on the body. It is caused by the same bacteria that causes strep throat. Scarlet fever was once a serious childhood illness. Now it can be treated with medicine and home care. Children generally recover from scarlet fever within a week after starting treatment.

Close up of hands giving liquid medicine to girl lying in bed.

What causes scarlet fever?

Scarlet fever is caused by strep (Streptococcus) bacteria. This is the same bacteria that causes strep throat.

How is scarlet fever spread?

Scarlet fever can be spread in the following ways:

  • Breathing infected air (the germs can enter the air when an infected person coughs or sneezes)

  • Contact with fluids (such as nasal fluids) from an infected person

  • Contact with items (such as cups, toothbrushes, or towels) that have been contaminated by an infected person

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 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 spots appear on the tongue, making it look like a strawberry)  

  • Muscle aches

  • Abdominal pain

  • Neck pain

  • Red eyes

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

How is scarlet fever diagnosed?

Your child’s healthcare provider asks about your child’s symptoms and health history. Your child is examined. If the provider thinks your child has scarlet fever, he or she 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 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 by mouth. Make sure your child takes all of the medicine, even if he or she feels better.

  • Your child is no longer contagious 24 hours after starting treatment. He or she can go back to school or daycare following full recovery.

  • Use children’s strength medicine for sore throat symptoms. Discuss all over-the-counter (OTC) products with your child’s provider before using them. Note: 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). Never give ibuprofen to an infant age 6 months or younger.

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

When should I call my child's healthcare provider?

Call the healthcare provider if your child has any of the following:

  • Fever (see Fever and children, below)

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

  • A rash that worsens

  • Significant peeling of the skin

  • Trouble swallowing

What are the long-term concerns?

There are usually no further problems once your child receives treatment. If untreated, scarlet fever can cause other serious 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

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.