Scarlet Fever In Children: Symptoms, Causes, Risks & Treatment

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Scarlet fever in children is a contagious bacterial disease that commonly affects five- to 15-year-olds (1). This illness, also called scarlatina, occurs in children affected by strep throat.

The most common clinical symptoms of scarlet fever are sore throat, high fever, and a bright red rash covering the entire body. If the condition aggravates, it could affect the vital organs, including the heart, kidneys, and liver.

Read this article to learn about the symptoms, causes, complications, treatment, and prevention of scarlet fever in children.

Signs And Symptoms Of Scarlet Fever

Scarlet fever may start with the following flu-like signs and symptoms in children (2)(3).

  • Fever
  • Chills
  • Swollen neck glands (large lumps on the sides of the neck)
  • Sore throat
  • Headache
  • Vomiting
  • Stomach pain
  • Coated white tongue
  • Strawberry-like colored tongue

The coated white tongue usually peels off and leaves the tongue swollen and red, with tiny bumps that appear like strawberries.

The scarlet fever skin rash develops after the onset of these flu-like symptoms. As these symptoms can also be seen in other conditions, seek medical care for the exact diagnosis and treatment.

Scarlet Fever Skin Rash

A skin rash usually appears one or two days after the onset of the first symptoms. This can be a red, sandpaper-like rash that often appears on the neck, cheeks, forehead, and chest. The cheeks may look red, and the rash does not appear on other parts of the face. The skin rash may spread to the back and arms as well. It is a papular, blanching rash that fades away when pressure is applied to it (3)(4).

Usually, scarlet fever rashes fade after two to seven days of onset. The skin in the rash areas, primarily on the hands, feet, and genitals, may peel after the infection subsides, and the peeling may continue for several weeks (4).

Causes And Risks Factors For Scarlet Fever

Scarlet fever is caused by the endotoxins of the bacteria group A streptococcus (group A strep or GAS). The gram-positive bacteria grow in chains and are also classified as beta-hemolytic strep (GABHS) (5).

The following risk factors may increase the likelihood of getting scarlet fever in children (6).

  • Children older than three years
  • Coming into close contact with someone who has a skin infection or strep throat
  • Living in an overcrowded environment such as daycare and boarding schools

Children younger than two years are less likely to develop the disease due to acquired maternal anti-exotoxin antibodies.

Group A strep bacteria can also cause cellulitis, necrotizing fasciitis, erysipelas, and impetigo in children.

Spread Of Scarlet Fever

Scarlet fever is a contagious infection that can spread from an infected person to another. Group A strep bacteria usually live in the throat and nose of infected people and spread to others via respiratory droplets while coughing or sneezing. Although not all people with these bacteria develop symptoms (asymptomatic) of strep throat or scarlet fever, they can spread the bacteria to others (1).

Your child can be infected if they come into close contact with an infected person or an asymptomatic carrier (they may carry the bug in their throat and spread the infection but have no symptoms themselves). Children can get group A strep bacteria in the following ways (1).

  • Breathing in respiratory droplets that contain the bacteria
  • Touching a surface that contains the droplet and touching the nose or mouth with unwashed hands
  • Sharing glasses, water bottles, spoons, toothbrushes, and plates with a sick person
  • Touching the sores of someone with group A strep skin infection (impetigo or school sores)

According to the Centers for Disease Control and Prevention (CDC), group A strep bacteria is rarely contracted from food that is not handled properly. Further, experts from the CDC do not believe that household items such as toys and pets spread these bacteria (1).

Complications Of Scarlet Fever

Although long-term health problems are not common in scarlet fever, they may happen if the bacteria spread to other parts of the body or if the infection is left untreated. The possible complications of scarlet fever may include (1)(4)

  • Septicemia
  • Vasculitis
  • Ear infections
  • Skin infections (impetigo)
  • Pockets of pus (abscesses) near the tonsils
  • Rheumatic fever (rheumatic heart disease)
  • Pneumonia (lung infection)
  • Arthritis (joint inflammation)

Complications may vary on a case-by-case basis. However, prompt antibiotic treatment may prevent most of these health problems.

Prevention Of Scarlet Fever In Children

Scarlet fever is highly infectious. Thus, taking the following precautions may help prevent or limit the spread of scarlet fever in children (4).

  • Wash hands with soap and water or use an alcohol-based sanitizer often.
  • Cover the nose and mouth with a tissue or the elbow while sneezing or coughing. Ensure to discard used tissues as soon as possible.
  • Do not share personal items such as clothes, towels, bedding, baths, cutlery, and cups with anyone who has scarlet fever or any of its symptoms.

Family members and caregivers should also follow these precautions to avoid getting infected with scarlet fever. Do not allow your child to go to daycare or school if you notice any symptoms of the infection, and inform the institution to prevent possible spread.

When To See A Doctor?

You may call the pediatrician if your child has symptoms of scarlet fever for early diagnosis and treatment. It is also recommended to inform your child’s doctor if new symptoms appear or the existing symptoms do not get better or get worse during the treatment period (2).

Diagnosis Of Scarlet Fever

Physical examination and health history, including the child’s symptoms and signs, can help establish a scarlet fever diagnosis. In addition, the skin rash and its onset may help differentiate scarlet fever from other diseases.

A throat swab is often collected to confirm that strep throat is the source of scarlet fever. Positive GABHS can be determined quickly on rapid tests. If the rapid strep test is negative, the doctor may send the sample to the laboratory for detailed analysis (2).

Treatment For Scarlet Fever In Children

Antibiotic treatment is prescribed for children after the streptococcal infection is confirmed. Usually, a ten-day course of oral penicillin is prescribed. Some children may receive a single dose of penicillin by intramuscular injection (6).

Children with penicillin allergies may receive alternative antibiotics such as erythromycin to treat scarlet fever. Other additional symptomatic treatments may include (6)

  • Paracetamol for fever, throat pain, and headache.
  • Emollients (topical substances to moisturize and soften skin) and oral antihistamines for pruritus (itch) of rash
  • Warm saline gargles help relieve throat pain

The fever may improve within 12-24 hours of antibiotic treatment, and most children recover completely within four to five days after the skin symptoms clear. However, it is recommended to complete the prescribed course of antibiotics (6) to prevent the development of rheumatic fever.

Home Remedies For Scarlet Fever In Children

Pediatricians may also recommend drinking plenty of water and cool liquids and eating soft foods if the child has severe throat pain. You may also trim your child’s fingernails to prevent skin damage from scratching.

The following home care measures may help children with scarlet fever (3).

  • Take antibiotics and fever medications as per the prescription.
  • Stay well hydrated to keep the throat moist since this may reduce throat irritation. Adequate fluid intake may also prevent dehydration.
  • Use cool mist humidifiers or other devices to humidify the room air. Dry air may irritate a sore nose and throat.
  • Gargling with salty water a few times a day can help reduce throat pain and irritation.
  • Give comforting foods, including warm soups to soothe the sore throat.
  • Avoid irritants such as cigarette smoke, fuming chemicals, strong sprays, and certain cleaning products since these may make the symptoms worse.
  • Give lozenges to children older than four years of age to reduce throat discomfort.

Prognosis Of Scarlet Fever

The prognosis of scarlet fever is excellent with antibiotic therapy and hygiene measures. Most children can return to their activities 24 hours after the fever subsides. Scarlet fever is not as common as it was a century ago when it was a deadly epidemic, thanks to the development of antibiotics and their early use in treating streptococcal infection, which prevented scarlet fever and its complications.

Frequently Asked Questions

1. Will Scarlet fever go away on its own?

If your child has mild symptoms of Scarlet fever, there are chances that it will get better on its own within a week. However, to avoid unwanted complications, it is advised to consult the doctor and take a medical opinion.

2. How long are kids contagious with Scarlet fever?

The contagious phase of Scarlet fever lasts for about six days until the diagnosis of symptoms and administration of antibiotics. In case the antibiotics are not taken, the child can remain contagious for two to three weeks (4).

When you notice signs and symptoms of scarlet fever in kids, do not overlook them or ignore a visit to the doctor. If you leave it untreated for days, there could be a risk of certain complications, including kidney injury, infections, and abscesses. Teaching good hygiene practices can help the infected children prevent the spread of scarlet fever. On contracting the disease, the doctor can prescribe medications and guide you through the treatment plan for your child. You may even try home remedies to relieve your child’s signs and symptoms.

Key Pointers

  • Scarlet fever is a contagious bacterial infection in children affected by strep throat.
  • The fever is accompanied by a red skin rash that occurs on the neck, forehead, cheeks, and chest.
  • Other symptoms may include swollen neck glands, vomiting, chills, etc.
  • Scarlet fever is caused by bacteria group A streptococcus and spreads through respiratory droplets, sharing utensils, etc.
  • Adequate hydration, saltwater gargle, cool mist humidifiers, and warm soups provide relief and help treat the condition fast.


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Dr Bisny T. Joseph

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 3+ 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 made... more

Dr. Anuradha Bansal

Dr. Anuradha Bansal is a pediatrician and neonatologist working as assistant professor in the Department of Paediatrics at PIMS Jalandhar. She has done her MBBS and MD Pediatrics at GMCH, Chandigarh. Thereafter, she polished her skills as senior resident at MAMC, Delhi. She has also done IAP Fellowship in Neonatology at GMCH, Chandigarh and obtained the membership of the prestigious... more