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Facts and advice from a pediatrician about rashes and red spots on children.
When rashes or red spots suddenly appear on your child, naturally, you begin to wonder why. As a pediatrician, I can sometimes recognize a rash in an instant. Other times I scratch my head, ask colleagues and dermatologists before I can make a diagnosis. In this blog you will find out how you to recognize different rashes, what viral spots are and what to do.
Is my baby sick?
The first thing to ask yourself when your child has a rash is, how are they feeling? Several infectious diseases have rashes as symptoms, and in most infectious diseases the child also has a fever. If your child is fit and well, you do not need to seek emergency medical care, no matter how many spots they have.
What does the rash look like and how do they feel?
Many rashes can be recognized by color and shape. Are they blisters, dry rashes or exuding rashes with yellowish crusts? Do they look like mosquito bites, like little red dots or like the child has burnt themselves on stinging nettles?
Feel the rash with your fingertips. Do they feel elevated? Course bumps? Hard bumps under the subcutaneous skin? Is the skin very dry? Can you feel it at all?
Chickenpox and shingles
Chickenpox presents as rashes consisting of blisters with clear contents e.g. vesicles, and are often red at the base. They can sit one by one on the body and can be just a few or very many. Notably, chickenpox itches a lot and your child will most likely have a fever the day before or on the first days of the disease.
If your child has had chickenpox, the virus lays dormant in the nerve cells. The immune system often keeps it in check throughout childhood. However, the virus may be reactivated. When this happens, it presents as blisters of the same type as chickenpox, but sit along a band of the skin, on one side of the body. The reactivated virus travels along a particular nerve pathway to your skin and thus produces the distinctive band shape.
If a child gets shingles on their face, go to the medical center or to an ophthalmologist. Antiviral medicine may be required if the rash is near the eye.
Hand, foot and mouth disease
Hand, foot and mouth disease is a type of viral blister that sit on the hands, feet and mouth. Sometimes they can hurt the mouth very much and make it difficult to eat. They often do not contain as much fluid as chickenpox blisters. Some types of hand, food and mouth blisters can cause the nails to fall off in the aftermath. This is not dangerous. There is no treatment for hand, foot and mouth disease, and they often come in epidemics in the fall.
Impetigo or school sores
Impetigo, or school sores, is a bacterial infection of the skin. They often sit around the mouth or under the nose, but can be found anywhere on the body. The skin around the impetigo blisters is red, inflamed and weep. The fluid solidifies into a honey-yellow crust and they can hurt quite a bit.
Hives or urticaria
Sometimes children get a rash that look like they have been burnt by stinging nettles without having been near any. They are red and raised in the middle, irregular in shape and red all around. The rash moves around the body and itches terribly.
Hives can also be a reaction to the heat or cold but most commonly appear spontaneously. The second most common reason is that they are associated to an infection.
Sometimes hives appear due to an acute allergic reaction. Sometimes hives only affect the skin e.g. when a child, who is allergic to milk, tastes milk-containing porridge and rashes may appear around the mouth. If the child is doing well, you can take a photo, wait and seek medical advice calmly to see if there is an allergy.
If, on the other hand, the child appears anxious, vomits, or has difficulty breathing, seek emergency medical care immediately. If necessary, call an ambulance. Hives can be part of a severe acute allergic reaction which needs to be treated in hospital.
Another type of rash that isn’t common but may have to do with allergy is eczema. Eczema is a small, scaly, red, rash that usually affects children who have dry skin. It is more common in children who have allergies and/or asthma.
Scarlet fever rash is red, spreads all over the body and feels like sandpaper. It always appears in conjunction with a fever. Scarlet fever is due to a streptococcal infection. If the infection is in the throat, you are likely to have tonsillitis at the same time. Scarlet fever should be treated with penicillin, so seek medical attention if you suspect scarlet fever.
Lyme disease in children is an infectious disease caused by the borrelia bacteria spread by tick bites. It is ring-shaped and not raised. You can sometimes have several ring-shaped rashes from a single tick bite and you may not always have seen the tick.
Lyme disease should be treated with penicillin so seek a medical center if you suspect Lyme disease.
Many viral diseases (e.g. the common cold) – in children can cause nonspecific dots. Often they are small, red dots that can itch a little but not so much. Viral spots heal with the cold.
Three-day fever is a very common viral infection in babies and young children. They get three days of high fever without other symptoms and after the three days, a fine-spotted rash all over the body. The children are otherwise well and recover quickly. Three-day fever does not need to be treated or controlled in any particular way.
Baby acne (Hormonal spots)
Infants often get hormonal spots or newborn rash during their first month. They look a lot like little pimples and are completely harmless.
During the summer, most children have mosquito bites. The mosquitoes usually sting in the evening or night and the bites itch and swell. Sometimes the bites can get really big.
Fifth Disease is a viral infection involving a virus called Parvovirus B19. It is usually harmless to the child affected but often causes fever and rash. The rash presents as wreath-shaped or laced pattern rash over the trunk and as very red cheeks characteristically known as ‘slapped cheek’.
Parvovirus B19 may in rare cases transiently affect the bone marrow (the tissue which produces blood cells). As a result, children produce less blood cells for some time but this usually sorts itself out. However if your child seems extra pale, or has a little bit of bleeding under the skin, you should absolutely seek medical care. This is when blood cells will be monitored with regular blood tests.
If a pregnant woman has not previously had Fifth Disease and is exposed to the infection during pregnancy, it can be dangerous for her expectant foetus if she becomes ill. If you are pregnant and worried about being exposed to Fifth Disease, contact your midwife for advice.
Small, pinhead-sized dark red dots that do not disappear when pressed and present with a little bit of bleeding under the skin are signs of petechiae. Petechiae can present on the face and neck after vomiting or severe constipation.
If the dots spread elsewhere on the body, or without signs of vomiting, your child needs to seek medical care as soon as possible for a blood test. I’d suggest they have their blood count checked, especially their platelet count (thrombocytes). Platelets play an important role in the clotting cascade that prevents bleeding.
The most common cause of low platelet count (thrombocytopenia) is ITP, idiopathic thrombocytopene purpura, which simply means that one does not know why your child is getting this. Children with ITP are otherwise healthy and fit with the treatments available.
If your child has petechiae and at the same time seems sick, you need to admit them to the emergency ward, preferably by ambulance, even if it is in the middle of the night. Severe types of septicaemia and meningitis can cause severe bleeding under the skin in the night and must be treated immediately with intensive care and antibiotics. They often cause a fever, but not always. Children with septicaemia or meningitis are always tired, dull and can sometimes be difficult to talk to, or they can complain of a headache or pain in the neck. This disease has a rapid onset and children can deteriorate by the hour.
Spots on children are often due to an infection or inflammation such as in eczema or hives. But most importantly, gauge how the child is feeling and make wise choices from there. When in doubt, don’t be afraid to seek medical care. Best of luck.