When Your Child Has Roseola

Roseola is a common viral infection in children under age 2. It is also known as sixth disease. Roseola is not a major health problem. It goes away on its own. And it doesn't need treatment. But you can do things to help your child feel better.

Roseola on light skin.

Roseola on dark skin.

What causes roseola?

Roseola is most often caused by a virus in the human herpes virus family. It is spread by droplets in the air when a person with the virus sneezes or coughs. It most often affects children ages 6 months to 2 years.

What are the symptoms of roseola?

Symptoms happen in stages. The stages are:

• Stage 1. Your child will have 3 to 7 days of high fever, such as 102°F ( 39°C) to 104°F ( 40°C). Your child is likely to feel cranky and uncomfortable during the fever. While your child has a fever, they can spread the virus to other children.

• Stage 2. A rash appears on the neck down to the torso after the fever goes away. The rash is red and can be raised or flat. It may spread to the face or arms and legs. The rash does not hurt, and it usually does not itch. It tends to get better and worse over 3 to 4 days. Your child may feel cranky or itchy during the rash stage of roseola. They are not contagious during the rash stage.

How is roseola diagnosed?

There is no test for roseola. It can’t be diagnosed until the fever has gone away and the rash has shown up. The doctor will examine your child. In some cases, a child may have some tests to check for other causes of fever.

How is roseola treated?

Roseola will go away on its own. To help your child feel better:

• Make sure they get plenty of rest and fluids.

• Give acetaminophen or ibuprofen to help relieve fever or discomfort, if advised by your child's doctor. Do not give ibuprofen to a baby age 6 months or younger. And don't give it to a child who is dehydrated or vomiting often. Do not give aspirin to children or teens unless your child's doctor says it is safe. Aspirin can put your child ask risk for Reye syndrome, a rare but serious condition.

• Give your child an anti-itch medicine (antihistamine) if the rash is itchy.

Returning to daycare

Once the fever has been gone for 24 hours, your child is no longer contagious. So even if your child still has the rash, they may go to daycare. But first ask your child's doctor if it's okay.

What are long-term concerns?

Roseola rarely becomes a long-term problem for children who are otherwise healthy.

When to contact your child’s doctor

Contact the doctor right away if your child has:

• A fever (see Fever and children below).

• A seizure caused by the fever.

• A fever that returns after the rash has gone away.

• A rash that gets much worse or does not begin to fade after 4 to 5 days.

• A rash that lasts longer than several weeks.

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 doctor 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 doctor 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 okay using a rectal thermometer, ask the doctor what type to use instead. When you talk with any health care providers about your child’s fever, tell them which type you used.

Below is when to contact the doctor if your child has a fever. Your child’s doctor may give you different numbers. Follow their instructions.

When to contact a doctor about your child’s fever

For a baby under 3 months old:

• First, ask your child’s doctor 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 doctor

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 doctor

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 doctor