Roseola
High fever followed by a rash in babies and toddlers
Quick Facts
- Type: Viral infection
- Who it affects: Mostly children 6 months to 2 years
- Common cause: Human herpesvirus 6 (and 7)
- Hallmark: High fever, then a rash as fever ends
Overview
Roseola is a common and usually mild viral illness that mainly affects babies and toddlers, most often between 6 months and 2 years of age. It is also called roseola infantum or sixth disease.
Its classic pattern is several days of high fever in an otherwise fairly well-looking child, followed by a pink rash that appears just as the fever breaks. The rash is the feature that often makes parents realize what the illness was. Roseola almost always resolves on its own without complications, and treatment is aimed at keeping the child comfortable and well hydrated during the fever.
Because the fever phase comes before the telltale rash, parents and doctors often cannot tell roseola apart from other common fevers until the rash appears. This is normal and expected, and it is one reason the illness is frequently only recognized in hindsight once the child starts to feel better.
Symptoms
Roseola typically unfolds in two phases: fever first, then rash.
- Sudden high fever, often lasting three to five days
- Mild irritability or fussiness
- Reduced appetite
- Mild cough, runny nose, or swollen glands in the neck
- A pink or rose-colored rash, usually flat or slightly raised, that appears as the fever breaks
- Rash starting on the trunk and spreading to the neck and limbs, usually not itchy
The child often seems relatively well despite the high fever. Because high fevers can occasionally trigger a brief febrile seizure in young children, it is helpful to know what to do if one occurs.
Causes
Roseola is most often caused by human herpesvirus 6, and sometimes human herpesvirus 7. These are common viruses, and most children are infected during early childhood.
The virus spreads through tiny droplets of saliva and respiratory secretions, often from a person who has the virus but no symptoms. After the first infection, the virus stays dormant in the body. Once a child has had roseola, they usually develop lasting immunity and do not get it again.
Risk Factors
- Being a young child, especially between 6 months and 2 years
- Contact with other young children in childcare or play settings
- Exposure to people who carry the virus without symptoms
Older children and adults are rarely affected because most people are infected and become immune early in life.
Diagnosis
Roseola is usually diagnosed from the typical sequence of symptoms, often only once the rash appears.
- Clinical observation: A high fever in an otherwise fairly well young child, followed by a rash as the fever breaks, is characteristic.
- Ruling out other causes: During the fever phase, before the rash, a doctor may evaluate for other infections.
- Tests are rarely needed: Specific testing is uncommon and usually reserved for unusual or severe cases.
Treatment
There is no specific treatment, and roseola almost always clears on its own. Care focuses on comfort during the fever.
- Fluids: Offer plenty of fluids to prevent dehydration during the fever.
- Fever and discomfort relief: Acetaminophen or ibuprofen as directed for the child's age; aspirin should not be given to children.
- Rest: Allowing the child to rest and recover.
- No rash treatment needed: The rash is harmless, not usually itchy, and fades on its own within a few days.
Most children are back to normal within about a week. Antibiotics do not help, because roseola is caused by a virus.
Prevention
- Encourage frequent handwashing among caregivers and children
- Avoid sharing cups and utensils
- Keep a child with a fever home from childcare until they are well
- Cover coughs and sneezes
There is no vaccine for roseola, and because it can spread from people without symptoms, it is difficult to prevent entirely. Good hygiene reduces the risk.
When to See a Doctor
Contact your child's doctor if the fever is very high, lasts more than about a week, or the child seems very unwell, unusually drowsy, or is not drinking enough.
Seek emergency care right away if your child has a seizure, difficulty breathing, a stiff neck, a rash that does not fade when pressed, repeated vomiting, or signs of dehydration such as no wet diapers, no tears, or sunken eyes. While brief febrile seizures from high fever are usually not harmful, any seizure should be evaluated.
Frequently Asked Questions
What is the typical pattern of roseola?
Roseola usually starts with several days of high fever in a child who otherwise looks fairly well, followed by a pink rash that appears just as the fever breaks. The rash is often how parents recognize the illness in hindsight.
Is roseola contagious?
Yes, it spreads through saliva and respiratory droplets, often from people who carry the virus without symptoms. A child is most contagious during the fever phase, so keeping a feverish child home helps limit spread.
Can roseola cause seizures?
The high fever can occasionally trigger a brief febrile seizure in young children. These are usually not harmful, but any seizure should be evaluated by a doctor, and you should seek emergency care if one occurs.
Does the rash need treatment?
No. The roseola rash is harmless, usually not itchy, and fades on its own within a few days. No creams or medicines are needed for it; care focuses on comfort and fluids during the fever.
When should I worry about a child with roseola?
Seek care if the fever is very high or lasts more than about a week, the child is very drowsy or not drinking, or there is a seizure, stiff neck, difficulty breathing, or a rash that does not fade when pressed, as these may point to a more serious illness.
References
- American Academy of Pediatrics.
- Mayo Clinic. Roseola — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Roseola.
- Centers for Disease Control and Prevention (CDC).