ConditionChildren's health
Roseola
Roseola is a common viral illness in babies and toddlers, usually between 6 months and 2 years, caused by human herpesvirus 6 (HHV-6) or 7. It typically causes a sudden high fever, often above 39.4 °C (103 °F), lasting 3 to 5 days, while the child may seem fairly well. As the fever breaks, a pink, flat or slightly raised rash appears on the chest, back and belly. It is usually mild and goes away without treatment, though the fever can trigger febrile seizures.
Also called: Roseola infantum, sixth disease, exanthem subitum, three-day fever
At a glance
- Cause
- Human herpesvirus 6 (most cases) or 7.
- Age
- Mostly 6 months to 2 years; nearly all children are infected by age 3 to 4.
- Pattern
- 3 to 5 days of high fever, then a pink rash as the fever goes.
- Rash
- Small pink spots on the trunk, spreading to the neck, face and limbs; not itchy; fades in 1 to 2 days.
- Main risk
- Febrile seizures during the fever in some children.
- Treatment
- Fluids, rest and fever medicine for comfort; no antiviral needed in healthy children.
When to get help
Call 911 or go to the ER
- A seizure lasting more than 5 minutes, repeated seizures, or a child who does not wake up normally after a seizure
- Difficulty breathing, blue or gray lips, or a very floppy, unresponsive child
- A rash that does not fade when pressed with a glass, with fever
- A stiff neck, bulging soft spot or persistent vomiting
See a doctor within a day or two
- Any fever of 38 °C (100.4 °F) or higher in a baby under 3 months
- A first febrile seizure, even if short and the child recovers
- Fever lasting more than 5 days, or fever above 40 °C (104 °F) that does not come down with medicine
- Signs of dehydration: fewer wet diapers, no tears, dry mouth
- A child with a weakened immune system who develops roseola symptoms
Book a routine appointment
- A rash that lasts more than 3 days or becomes itchy or blistered
Usually safe to manage at home
- A toddler who had a few days of fever, is now fever-free with a pink rash, and is eating, drinking and playing
What causes roseola
Roseola is caused by human herpesvirus 6 (HHV-6), mainly type 6B, and sometimes human herpesvirus 7. These are not the viruses that cause cold sores or genital herpes. Almost all children catch HHV-6 by age 3, often without noticeable illness. Like other herpesviruses, it stays in the body for life, usually without causing further problems.
It spreads through saliva and respiratory droplets, often from adults or older siblings who carry the virus without symptoms. The incubation period is about 9 to 10 days.
Symptoms
Fever phase (3 to 5 days)
- sudden high fever, often 39.4 to 40.6 °C (103 to 105 °F)
- irritability, fussiness and reduced appetite
- mild runny nose, cough or sore throat
- swollen lymph nodes in the neck
- mild diarrhea
- swollen eyelids
- small red spots on the soft palate (Nagayama spots)
Many children remain surprisingly alert and playful between fever peaks.
Rash phase (1 to 2 days)
As the fever breaks, a rash appears:
- small, pink, flat or slightly raised spots, some with a pale ring around them
- starts on the chest, back and belly, spreading to the neck, face and arms
- blanches (fades) when pressed
- not itchy or painful
- fades within 1 to 2 days without peeling
Once the rash appears, the child usually feels better.
Febrile seizures
About 1 in 10 to 15 children with roseola have a febrile seizure during the fever. These seizures usually last less than 5 minutes and do not cause brain damage. They are frightening but rarely dangerous.
During a seizure:
- place the child on a safe surface on their side
- do not put anything in their mouth
- time the seizure
- call 911 if it lasts more than 5 minutes or the child has trouble breathing
Roseola vs other childhood rashes
| Illness | Fever and rash timing | Clues |
|---|---|---|
| Roseola | Rash appears as fever goes away | Child improves once rash appears |
| Measles | Rash appears while fever is high and spreads from the face down | Cough, runny nose, red eyes; child very unwell |
| Fifth disease | Mild or no fever | "Slapped cheek" rash then lacy body rash |
| Scarlet fever | Rash with fever and sore throat | Sandpaper rash, strawberry tongue |
| Hand, foot and mouth disease | Fever with sores | Blisters on hands, feet and mouth |
| Drug rash | Rash after starting a medicine | Often after antibiotics given for the fever |
Because roseola fever often leads to antibiotics, the rash is sometimes mistaken for an antibiotic allergy.
Diagnosis
Roseola is usually diagnosed from the typical pattern of high fever followed by rash. Tests are rarely needed. During the fever phase, before the rash, doctors may check for other causes of fever, such as a urinary tract or ear infection, especially in young babies.
Treatment
There is no specific treatment for roseola in healthy children. Care focuses on comfort:
- fluids: offer breast milk, formula or water frequently
- fever medicine: acetaminophen (paracetamol) or ibuprofen (for babies 6 months and older), using the dose for your child's weight on the label. Do not give aspirin to children or teenagers
- light clothing and a comfortable room temperature
- rest
Fever medicines make children more comfortable but do not prevent febrile seizures. The rash needs no treatment.
Antiviral medicines may be used for children with weakened immune systems, who can develop serious complications.
Is roseola contagious?
Roseola is contagious during the fever phase, before the rash appears. Once the rash appears and the child has been fever-free for 24 hours, they are generally no longer contagious and can return to childcare. Handwashing and not sharing cups help reduce spread.
Frequently asked questions
What does roseola look like?
The rash consists of small pink spots, flat or slightly raised, that start on the chest, back and belly and spread to the neck and arms. It appears as a high fever goes away, is not itchy, and fades within 1 to 2 days.
How long does roseola last?
The fever usually lasts 3 to 5 days, followed by a rash for 1 to 2 days. Most children are back to normal within a week.
Is roseola contagious?
Yes, mainly during the fever phase before the rash appears. By the time the rash shows, children are usually much less contagious. They can return to childcare when fever-free for 24 hours.
Can adults get roseola?
Most adults had HHV-6 in early childhood and are immune. Adults can carry and shed the virus without symptoms. Rarely, the virus reactivates in people with weakened immune systems, such as after transplants.
Can roseola cause seizures?
Yes. About 1 in 10 to 15 children with roseola have a febrile seizure during the high-fever phase. These are usually brief and harmless, but a first seizure or one lasting more than 5 minutes needs medical attention.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Pediatrics (HealthyChildren.org): Roseola
- MedlinePlus: Roseola
- CDC: Human Herpesvirus 6
- NHS: Roseola
- Merck Manual Consumer Version: Roseola