Scarlet fever in children

Scarlet fever is a common childhood infection caused by a type of bacteria called group A streptococcus. It often follows a sore throat or skin infection and is most common in children under 10. While it can sound concerning, it is usually mild and can be treated effectively with antibiotics.

This guide explains the symptoms, how scarlet fever spreads, and what to do if your child becomes unwell.

Red rash on the hands of the palms of the child, rubella scarlet fever Coxsackie and other infectious viral diseases in children and adults

What is scarlet fever?

Scarlet fever is a bacterial illness that typically starts with flu-like symptoms, followed by a distinctive rash. It used to be a serious childhood illness but is now much less dangerous thanks to prompt treatment with antibiotics.

Scarlet fever can spread easily from person to person, particularly in places where children are in close contact, such as nurseries and schools.

Signs and symptoms of scarlet fever

The early symptoms are similar to many viral illnesses. These include:

Sore throat
High temperature (fever)
Headache
Feeling unwell
Swollen neck glands

After these symptoms begin, a rash usually appears within 12 to 48 hours. It may:

Start on the chest or tummy and then spread
Feel rough to the touch, like sandpaper
Appear red or flushed, especially on the cheeks
Be more difficult to notice on brown or black skin, but the rough texture and warmth may still be felt

Other signs may include:

A white coating on the tongue which peels away, leaving the tongue red and swollen (known as “strawberry tongue”)
Flushed face with a pale area around the mouth
Peeling skin on the fingertips or toes as the rash fades

Is scarlet fever contagious?

Yes, scarlet fever spreads through close contact with someone who is infected, usually by coughs, sneezes or sharing items like cups or utensils. Children are most contagious in the early stages of the illness and until 24 hours after starting antibiotics.

If your child is diagnosed with scarlet fever, they should stay at home and avoid nursery or school for at least 24 hours after beginning treatment.

When to seek medical advice

You should contact your GP if your child:

Shows symptoms of scarlet fever
Has a sore throat and fever along with a new rash
Becomes more unwell or has difficulty eating, drinking or breathing

Scarlet fever is usually diagnosed based on symptoms. A throat swab is sometimes taken to confirm the infection.

Treatment for scarlet fever

Scarlet fever is treated with a course of antibiotics, usually penicillin. This helps to:

Reduce the severity and duration of symptoms
Prevent complications
Stop the infection spreading to others

It is important to complete the full course of antibiotics, even if your child feels better after a few days.

You can also help manage your child’s symptoms by:

Encouraging rest and plenty of fluids
Offering paracetamol or ibuprofen for fever or discomfort (check the correct dose for your child’s age)
Keeping them cool and comfortable while the rash is present

Possible complications

Most children recover fully with no lasting problems. However, in rare cases, scarlet fever can lead to complications if not treated properly. These may include:

Ear infections
Throat abscesses
Sinus infections
Kidney inflammation (post-streptococcal glomerulonephritis)
Rheumatic fever

Prompt antibiotic treatment greatly reduces the risk of complications.

How to prevent the spread

To help prevent scarlet fever from spreading:

Keep your child at home for at least 24 hours after starting antibiotics
Encourage regular handwashing with soap and water
Avoid sharing cups, utensils, towels and other personal items
Teach children to cover their mouth and nose with a tissue or elbow when coughing or sneezing

If you are concerned that your child may have scarlet fever, please speak to your GP or book an appointment with the Childhealthy team.

Disclaimer: This article is intended for information only and should not be used as a substitute for medical care and advice. Always speak to a healthcare professional if you are concerned about your child’s health.