making sense of children's rashes!
other then Chicken Pox and Measles what other rashes should I be aware of?
Between birth and the age of five, our children frequently develop rashes, usually without any problems. Some of the rashes are clearly related to having a minor virus, and others to physical trauma to the skin, from things such as cold dry wind on the face, to sunburn on the arms and legs. Even cold water splashed on the skin can cause Urticaria – also called hives.
deciding when to see the doctor
If your child is happy, and the rash does not bother him or her, you don't need to see anyone. Most of these rashes can stay around for weeks. They will eventually go away on their own. Your doctor should assess any rash that persists for more than four weeks.
The one rash that requires an urgent visit to your doctor or Children’s Emergency Service visit right away is called Petechiae or Purpura. Petechiae is caused by ruptured blood vessels under the skin. Petechiae appear as tiny, red, pinpoint, flat spots. They look as if someone used a fine-tip red pen to put little dots on the skin. Purpura is similar, but is larger and can be more purple or blue in colour.
The two most important signs that you can use to distinguish these spots from other rashes are:
- They don't blanch when you press on them with a clear glass object. Many other kinds of spots, when pressed, will turn white or skin coloured for 1 or 2 seconds, and then turn red again. Petechiae and Purpura will stay red or purple. They won't blanch at all when pressed.
- They are completely flat. Because they occur under the skin, you won't be able to feel any bump.
There is one situation where Petechiae are not urgent. If your child has a very bad cough or is vomiting, the pressure in the head can cause little blood vessels in the skin of the face and neck to rupture and form Petechiae. These Petechiae are OK. They are nothing to worry about. Petechiae or Purpura found anywhere else on the body besides the face and neck could be a sign of a bleeding problem or a serious infection. If you suspect this rash you should see your doctor immediately, or be assessed in a Children’s Emergency Service after hours.
viral rashes
In the winter months the common rashes are usually due to viruses. Some viruses can be easily identified, including Chicken Pox, Fifth Disease (Slapped Cheek), and Roseola. Most viruses, however, do not cause their own specific type of rash as Chicken Pox does. The generality of viruses which cause rashes can have many different appearances, such as lacy or pimply, raised or flat, bumps, spots, or blotches, and they often (but not always) start on the trunk, and then spreads to the arms and legs.
The most important thing is that if your child has a fever or is not feeling well, and breaks out in one of these generic rashes, then it is probably a harmless virus and nothing to worry about.
Here is a brief description of some identifiable viral rashes:
Chicken Pox – this starts off with a few red spots or bumps (often mistaken for insect bites). Fever is common. The next day many more bumps will appear, and the first bumps will have turned into blisters. On the third day, new bumps will appear, and the second-day bumps will start to blister. On day four the original blisters will start to crust over. Usually by day five, no new bumps will appear, and more blisters will crust over. By day seven, most or all of the blisters will be crusted over. The fever can last for five days. Once the fever is gone and all the blisters are crusted over, your child is no longer contagious. It is nearly impossible to diagnose Chicken Pox on day one, and still difficult to know for certain on day two. Therefore, do not bring your child into the doctor on day one or two and expect a definite diagnosis. If you think it’s Chicken Pox, then quarantine your child until day three. If the spots have progressed as described above, then you probably don't even need a doctor to confirm it. When you first notice some spots draw a circle around a few of them. If they change into blisters within 24 hours, consider it Chicken Pox.
Fifth Disease (or Slapped Cheek disease) – this is a very common virus, and is particularly common in day nurseries where it spreads really quickly. It starts out causing bright red cheeks (it looks like your child has been slapped), and sometimes a fever. Then a lacy or pimply rash spreads from the trunk to the extremities. There may also be a runny nose and cough.
Roseola – this is one of the most common causes of fever and rash in infants and young children. It starts out with three days of moderate to high fevers, with no other symptoms. Just when you start to get worried, the fever settles on day four and your infant develops the rash yet appears almost entirely well. The rash consists of red spots and bumps starting on the upper back and neck, spreading down the trunk and into the extremities. It sometimes has a lacy appearance.
Coxsackie – blisters on hands, feet, or mouth - this is more commonly known as Hand, Foot and Mouth disease and is caused by a virus called Coxsackie.
contagious period
Most viral illness are contagious starting the day before the rash and fever start, and are no longer contagious after the fever has been gone for 24 hours without using any paracetamol, even though most rashes will continue. Chicken Pox is the exception as it is infectious for about five days before the rash appears and remains infectious until the last new spot has appeared.
