Roseola In Children: Symptoms, Causes, Treatment & Prevention

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Roseola in children is often caused by human herpesvirus 6 (HHV-6) and less frequently by human herpesvirus 7 (HHV-7) (1). Usually, most children get roseola infection before four years of age, and children younger than two years are commonly affected (2).

This viral infection is also called exanthema subitum, roseola infantum, or the sixth disease, and is highly contagious. Nevertheless, it is a self-limiting disease. Most children can be treated symptomatically.

Read on to know more about this contagious viral infection, its symptoms, causes, diagnosis, treatment, and preventive measures.

Risk Factors And Causes Of Roseola In Children

Roseola in children is often caused by human herpesvirus 6 (HHV-6) and less frequently by human herpesvirus 7 (HHV-7). Usually, most children get roseola infection before four years of age, and children younger than two years are commonly affected.

Infants and children may get the virus from close contact with asymptomatic family members and caregivers and direct contact with an infected person’s respiratory secretions or saliva. Roseola rarely affects older children since most have already had the illness at a young age.

Symptoms Of Roseola In Children

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The signs and symptoms may vary in each child; however, the following signs and symptoms are commonly seen in children with roseola (2) (3).

• Sudden onset of a high fever that lasts three to four days
• Cold-like symptoms such as runny nose, cough, or sore throat
• Irritability
• Loss of appetite
• Swollen eyelids
• Skin rash after fever
• Swollen glands

A mother narrates her experience when she observed roseola rashes develop in her daughter following a fever without additional symptoms. She says, “I woke Joanna (her daughter) up one morning and found that she has a slight fever, then I thought she caught the flu I got a few days back. The fever rose to 37.7c, so I gave her a fever reliever and took a doctor’s appointment for the next day. In the morning, I noticed small pink spots on her face and a rash, and I checked her tummy and back and found the same small spots. I freaked out; I thought it was chicken pox. I rushed to her doctor, and when we reached and he was done examining her, he told me it was not chicken pox (that was a relief); it was Roseola! (i).”

Roseola rash appears after the fever subsides. You may initially notice a flat or raised pink rash on the trunk (tummy, chest, and back), which may then spread to the face, arms, and legs (3). Usually, the skin rashes in roseola fade within two days without leaving any marks on the skin.

Roseola Vs. Measles Rash

Though a roseola rash may be mistaken for a measles rash, there are certain characteristic differences that may help you tell them apart (4):

How Long Is Roseola Contagious?

Most roseola symptoms may last for three to five days, and the child is most contagious during this period, meaning they can spread the disease to other children or anyone after the onset of the symptoms until the rash occurs (4). A child is no longer contagious 24 hours after the fever subsides, even if the rash is present.

Complications Of Roseola In Children

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Roseola usually does not cause serious complications (5). However, high fever may result in febrile seizuresⁱXSudden and abnormal surges of electrical activity in the brain characterized by jerking body movements and loss of consciousness. in some children. According to StatPearls Publishing by National Library of Medicine, febrile seizures are prevalent among 15% of children within the febrile phase of Roseola infantum. Children with high fever can also experience dehydration if they do not drink enough water during the illness. In a few cases, roseola can lead to ear infections in some children.

Can Children Get Roseola Twice?

The immune system develops antibodies against the roseola virus after the initial infection. Due to this, most children get roseola just once in their life (4). These antibodies can prevent viruses from causing diseases.

However, children with weakened immune systems may get roseola infection more than once since their immune system may not develop a proper defense against the disease.

Prevention Of Roseola In Children

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There is no vaccine or medications to prevent roseola (4). However, frequently washing the hands may help prevent roseola and many other common childhood illnesses, such as hand-foot-mouth disease (6). Practicing cough and sneeze etiquette may also prevent the spread of the disease.

Ensure you do not send your child to school if they have a fever or any other symptoms of roseola, and avoid exposing your child to another child with the infection.

When To Call A Doctor?

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You may contact the pediatrician if your child develops severe breathing problems and signs of pneumonia. High degree fever may also require treatment to prevent seizures in children. Seizures, signs of dehydration, fatigue, or itchy or painful rashes are also indications you need to seek medical care.

Although roseola is not a severe disease, you may seek pediatrician help to prevent complications and exclude other conditions. Some studies show roseola can cause severe infections, such as meningitis and encephalitis, albeit in rare cases.

Be watchful

Slurred speech, confused demeanor, and blue, pale, or blotchy skin, lips, or tongue also warrants prompt medical evaluation (3).

Diagnosis Of Roseola In Children

A complete health history and the symptoms may help doctors in diagnosis. The onset and characteristics of skin rash and other symptoms may help the doctors confirm the diagnosis.

However, the diagnosis can often be confused with other conditions, such as chickenpox rubellaⁱXA viral infection (also called German measles) characterized by pink or red rashes, fever, and sore throat. or measlesⁱXA highly contagious viral infection that can cause fever, rash, and other severe symptoms in children, often preventable by a vaccine. (5). In rare cases, a blood test is ordered to identify antibodies to roseola in a child’s body.

Treatment For Roseola

There is no specific vaccine or immunization for roseola. The treatment options may depend on the child’s age, health status, and severity of symptoms. Antiviral medications such as Cytovene (ganciclovir) are often prescribed for children with weakened immune systems (7).

Fever medications are prescribed for children with a high fever. Skin rash due to roseola does not require specific care since it does not cause any discomfort. Always remember that antibiotics are not used for treating roseola since it is a viral disease.

Children with roseola can return to school or childcare centers 24 hours after the fever subsides, even if they have skin rashes since they are no longer contagious.

Point to consider

Never give children ice-cold baths or alcohol rubs. Also, mild sponge baths have no impact and are typically uncomfortable for children (10).

Home Remedies For Roseola In Children

The following home remedies may help ease the symptoms of roseola in children (8).

• Give them plenty of water to prevent dehydration.
• Provide soft foods if your child has a sore throat.
• Give fever medications, such as acetaminophen (Tylenol), as per the doctor’s advice.
• Dress them in cotton or lightweight clothing to prevent excessive sweating during fever.

Do not give ibuprofen to children younger than six months and aspirin to children of all ages to treat fever.

Infographic: Differential Diagnosis Of Roseola In Children

Roseola is a common pediatric disease; however, given the number of conditions that can cause rashes in children, it can easily be misdiagnosed, causing a delay in the treatment. But awareness of the illnesses resembling roseola can help rule them out. Take a look at the infographic below to learn more about these conditions and their distinctive characteristics.

Illustration: Momjunction Design Team

This video shows the roseola rash and its symptoms in children. Watch to recognize and identify this common childhood illness.

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Dr. Dur Afshar AghaMS

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association. She has also completed her Post...more

Dr Bisny T. JosephMedical Doctor

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has around 5 years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education...more

Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to...more

Vidya TadapatriMSc (Biotechnology)

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over five years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology. Vidya writes health-based articles...more