Scarlet fever in children: signs, symptoms and treatment

Scarlet fever is a common contagious bacterial infection that can cause an extensive rash. Our expert GP explains how to spot the early symptoms and what to do if you think your child has caught it

scarlet fever rash on white skin and on black skin

Scarlet fever, in a nutshell: Scarlet fever is a common childhood illness, caused by bacterial infection. Before antibiotics, it was very serious – even fatal – in childhood. Now, most cases are very mild and, with proper treatment, usually clear up quickly. But there is a small risk of the infection spreading to other parts of your child’s body, such as their ears, sinuses and lungs.

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How do I spot the signs of scarlet fever?

Symptoms of scarlet fever infection can start a few days before the classic rash (pictured above) develops. These are usually flu-like symptoms and include:

  • a high temperature
  • headache
  • aches and pains in the limbs
  • sore throat
  • swollen glands in the neck

When the rash appears, the spots will be fine (the size of a pinhead) and feel rough and sandpaper-like to the touch. On white skin, they will look bright pink or red (pictured, above left); on black skin (pictured, above right), they may not be so visible.

The scarlet fever rash can look quite impressive – all over most of the body and bright red on some skin types
Dr Philippa Kaye, expert family GP and mum of 3

The rash may start on the tummy or chest but it soon spreads to affect the neck, back and ears. The rash can appear on your child’s cheeks but tend to spares the rest of their face, so the areas around the mouth can look very pale or clear in comparison. It may be itchy.

Your child may also have a ‘strawberry tongue’, where a white coating appears on the tongue and then peels off, leaving the tongue looking very red, swollen and covered in little bumps.

Is there a time of the year when my child’s more likely to get scarlet fever?

Scarlet fever can occur at any time but it is more common in the winter and spring months.

Are young children more at risk of catching scarlet fever than adults?

Yes. Anybody can catch it but it’s most common in children between the ages of 5 and 10 years.

How do you catch scarlet fever?

Scarlet fever can be caught:

  • by breathing in bacteria from airborne droplets that an infected person is sneezing or coughing out
  • by touching someone with a streptococcal skin infection, or by sharing contaminated towels, clothes or bedlinen with them
  • from ‘carriers’: people who naturally harbour the bacteria in their throat or on their skin but don’t show any symptoms

What should I do if I think my child has scarlet fever?

If you think your child is infected, get help from your GP as soon as possible (your GP may suggest a phone consultation, rather than an in-person appointment because scarlet fever is so contagious).

The normal treatment is a 10-day course of antibiotics. Once treatment is started, the fever usually disappears within 24 hours and the rash fades within a few days. The skin can start to peel and flake, as the rash fades.

Now we have antibiotics to treat scarlet fever, what was once a much-feared and potentially fatal illness is a treatable one
Dr Philippa Kaye, expert family GP and mum of 3

You can give your child age-appropriate doses of paracetamol or ibuprofen if they are feverish and in pain or seem not themselves. And make sure they are drinking plenty of fluids.

Whether or not your child is already having treatment, if they become more unwell – their fever doesn’t come down with paracetamol or ibuprofen, for example, or they stop weeing, or become floppy or drowsy – you should seek urgent medical advice.

Most children recover completely within 4 to 5 days but it’s important to complete the course of antibiotics, even if they’re feeling loads better.

If your child has had scarlet fever and then becomes unwell again a few weeks later, see your GP to rule out the development of complications such as rheumatic fever. These are less likely if your child has been treated with antibiotics.

Do I need to keep my child at home if they have scarlet fever?

Yes. Scarlet fever is contagious, so any child with the illness should stay at home for at least 24 hours after antibiotic treatment has begun to help prevent spreading the infection to others.

If your child has scarlet fever but isn’t taking antibiotics, they will be infectious for much longer: up to 2 or 3 weeks after the first symptoms start.

How can I stop other members of my family catching scarlet fever?

To help stop yourself and others in your family catching it, keep washing your hands and your child’s hands thoroughly with soap and water. And, while your child is still contagious, don’t let anyone share their cutlery, plates, cups, glasses, towels, bedding or baths.

About our expert Dr Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

Last updated 6 January 2022.

Pics: Science Photo Library/@brownskinmatters

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