Spotted on the horizon: Roseola

Your toddler wakes from his afternoon nap a tad grumpy and with flushed cheeks. You grab your thermometer and see that his temperature is… 104F! But, because you have read our prior posts about fever Part 1 and Part 2, you do not panic. He has no cough, no runny nose, no vomiting, no diarrhea, no rash. He is fully immunized. In fact, considering how well he was acting before his nap, you are very surprised to find fever. You give him Tylenol and and hour later he becomes a happy toddler. This pattern continues for three days. He has fever, but no new symptoms, and he continues to run about energetically.  On the fourth day, the  fever breaks. A rash pops up, and your pediatrician diagnoses your child with roseola.

A viral illness seen in kids typically between six months and two years of age, roseola usually runs a course similar to your toddler’s illness and requires no specific treatment.  Many kids remain relatively cheerful despite the fever, and those who become fretful regain their good moods after a fever reducer medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) is administered. The associated light-pink rash may cover a child from head to toe as seen in our photo. The rash does not itch or hurt. Once the rash appears, the child is no longer contagious. If you press on the rash and lift up, the redness will momentarily turn white (blanches). It lasts for hours to a few days, and then fades. Up to 50% of affected kids never even get the rash. 

My twins had roseola at age 18 months. I remember one had fever for three days, the other had fever for two days, and both acted quite well despite their high temperatures. I kept waiting for more symptoms, dreading what I thought would turn out to be twin colds or worse, twin stomach viruses (double diarrhea really stinks), but no other symptoms emerged. When one broke out in a rash, I remember thinking “Oh finally, I know what you both have… roseola.” My other twin never did get the rash.  Thus, I suppose my family shows that 50% of affected kids really don’t get the rash.

What else causes fever for a few days and no other symptoms in a young child? In girls and uncircumcised boys, we mainly worry fever alone can be the sole sign of a urinary tract infection. 

In general, if your child seems especially ill, refuses to drink, becomes difficult to console, has any new rash WITH FEVER, or has fever alone for MORE than a few days, then you should call your child’s doctor. For more information on when to call your child’s physician, please see our “How sick is sick” post.

Now that you’ve learned about the symptoms, if you recognize Roseola, you’ll be “spot on”.

Julie Kardos, MD with Naline Lai, MD

©2011 Two Peds in a Pod®

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