Scarlet Fever
Scarlet fever is an illness caused by a bug called Group A Streptococcus, which is found on the skin and in the throat. Scarlet fever mostly affects children and can easily spread to other people.
Generally, scarlet fever is much less common than it used to be but in the last few years there have been a number of outbreaks. It is important that children with scarlet fever are assessed by a healthcare professional so that they can be started on antibiotics.
The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 days. The rash may be harder to see on darker skin tones. It often feels like 'sandpaper' but is not itchy.
Your child may also have a:
- Sore throat or tonsillitis
- Fever (temperature of 38°C or above)
- Painful, swollen glands in the neck
- A red tongue (strawberry tongue)
If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.
Please see Red-Amber-Green tables for advice on when and where to seek care for your child.
When should you worry?
If your child has any of the following:
- Breathing very fast, too breathless to talk, eat or drink
- Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
- Breathing that stops or pauses
- Is pale, blue, mottled or feels unusually cold to touch
- Difficult to wake up, very sleepy or confused
- Weak, high-pitched cry or can’t be settled
- Has a fit (seizure)
- Has a rash that does not go away with pressure (the glass test)
- Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or or call 999 - dial 999.
If your child has any of the following:
- Unable to swallow saliva
- Painful, red swollen neck glands
- Painful, swollen joints
- Puffy face or eyelids
- Dark coca-cola coloured wee (urine)
- Develops red lips or a red tongue
- Develops a lot of skin peeling
- Breathing a bit faster than normal or working a bit harder to breathe
- Dry skin, lips or tongue
- Not had a wee or wet nappy in last 8 hours
- Poor feeding in babies (less than half of their usual amount)
- Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
- Not using or putting weight on an arm, leg, hand or foot.
- Complaining of severe pain that is not improving with painkillers
- Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
- Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
- Temperature less than 36°C in those over 3 months
- Getting worse and I am still worried
You need to contact a doctor or nurse today.
Please contact your GP surgery or call NHS 111 - dial 111.
If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.
If none of the above features are present
- Watch them closely for any change and look out for any red or amber symptoms
- If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways
- Additional advice is also available to young families for coping with crying of well babies
- If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.
Self-care
Continue providing your child’s care at home. If you are still concerned about your child, speak to your health visitor, local pharmacist or call NHS 111– dial 111. Keep monitoring your child for red and amber features and seek help if they develop.
Children and young people who are unwell and have a high temperature should stay at home. They can go back to school, college or childcare when they no longer have a high temperature, and they are well enough to attend.
Advice and Guidance
Self care and Prevention
Scarlet fever last for around 1 week. If you do not take antibiotics, you can spread the infection for 2-3 weeks after your symptoms start.
Important
Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.
Self-care
Many of the symptoms of scarlet fever can be relieved using some simple self-care measures, such as:
- drinking plenty of cool fluids
- eating soft foods (if your throat is painful)
- taking paracetamol to bring down a high temperature/distress
- using calamine lotion or antihistamine tablets to relieve itching
Most cases of scarlet fever don't cause problems, particularly if the condition is properly treated.
Rarely, the infection can spread to other parts of the body and cause more serious infections such as chest infections, bone and joint infections and sepsis.
Some of the problems can arise a few weeks after infection including kidney problems and joint issues, Please get in touch with your GP if you are concerned.
Scarlet fever is very contagious and can easily spread to other people. To reduce the chance of spreading Scarlet fever:
Do:
- wash your hands often with soap and water
- use tissues to trap germs from coughs or sneezes
- bin used tissues as quickly as possible
Don’t:
- do not share cutlery, cups, towels, clothes, bedding or baths with anyone who has symptoms of scarlet fever
If your child has been in close contact with a case of scarlet fever or strep throat, they do not need to be treated with antibiotics unless they are showing signs of infection (severe tonsillitis with fever in the absence of a runny nose or signs of scarlet fever). Only in exceptional circumstances will the local public health team recommend for an entire school class to be treated with antibiotics.
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