Roseola

What is roseola?

Roseola is a viral infection that mostly affects babies and young children, typically in the first two years of life. Roseola causes a sudden, high fever that lasts about three to four days. After the fever breaks, some children develop a rash that lasts two to four days. Most children can recover at home in a week or less.

Roseola is often harmless and doesn’t lead to complications. However, it’s important to know that febrile seizures are a possible complication. These are mild, short-lived seizures that usually have no lasting effects but can be scary to witness. Children who have weakened immune systems may have more serious complications from roseola.

Your child can catch roseola any time of year, but it’s most common in the spring and fall. Roseola is contagious and spreads through saliva or respiratory droplets, often from people who don’t yet have any symptoms. Your child is no longer contagious once their fever has been gone for 24 hours.

Other names for roseola include:

• Roseola infantum.
• Sixth disease (because it was the sixth common childhood rash that scientists named).
• Baby measles.
• Three-day fever.
• Exanthem subitum (which means “sudden rash”).

How common is roseola?

Roseola is very common and affects nearly all children by their second birthday. In the U.S., roseola causes up to 45% of all fevers in infants. Of all infants who need care for a fever at an emergency room (ER), about 12% have roseola.

While roseola can cause sickness at any age, it mostly occurs in babies and toddlers. It’s rare for an older child or adult to come down with roseola.

What are the symptoms of roseola?

The main roseola symptom is a sudden and high fever, typically ranging from 103 to 105 degrees Fahrenheit (39.5 to 40.5 degrees Celsius).

A rash may develop all over your child’s body after the fever goes away.

Additional roseola symptoms and signs

In the period before a roseola rash appears, some children may also have:

• Vomiting.
• Diarrhea.
• Loss of appetite.
• Cough.
• Sore throat.
• Runny nose.
• Pink eye.
• Swelling of their eyelids or the area around their eyes.
• Swollen lymph nodes in their neck or the back of their head.
• Small pink or red spots along their throat.

Roseola rash

Your child may develop a rash within 24 hours of their fever breaking. It looks like pinkish-red spots on children with lighter skin tones, and it may be harder to notice on children with darker skin tones. The rash may be entirely flat or have both flat and raised areas. The spots will fade or turn white if you press on them.

The rash usually starts on your child’s chest, back and tummy. It soon spreads to their face, neck, arms and legs. It can be alarming to see a rash spread over your baby’s body, but try not to worry too much. A roseola rash doesn’t cause itching or discomfort, and it doesn’t last long. You can expect it to disappear within two to four days.

A key feature of a roseola rash is that, unlike some other rashes, it only appears after your child’s fever is gone.

Roseola vs. measles rash

Both roseola and measles can cause a rash. Here are some differences between the two:

• Color of the spots. A roseola rash is often pink-red in color, while a measles rash is red or red-brown. A measles rash may have small, raised white spots on top of the red spots.
• How the spots connect. With a roseola rash, the spots are usually separate (discrete) and don’t join up with one another. With a measles rash, the spots are more likely to join together.
• Where the rash starts. A roseola rash starts on your child’s chest, back and tummy. It then spreads outward in all directions. A measles rash starts on your child’s face and then moves downward to cover the rest of their body.
• Skin peeling as the rash goes away. A roseola rash doesn’t cause your child’s skin to flake or peel away. A measles rash does.

If you’re concerned your child has measles, call your pediatrician right away. Measles is a more serious illness than roseola and can lead to serious complications. It’s also highly contagious and spreads through the air.

You can protect your child against measles by giving them either of these vaccines:

• Measles, mumps, rubella (MMR) vaccine.
• Measles, mumps, rubella, varicella (MMRV) vaccine.

What causes roseola?

Roseola is a viral infection, meaning your child is exposed to a virus that makes them sick. The human herpesvirus 6 causes most cases of roseola. The human herpesvirus 7 causes a few cases.

Is roseola contagious?

Yes, roseola is contagious. It spreads through the saliva and respiratory droplets (from a cough or sneeze) of someone who has a fever or doesn’t yet have symptoms. It takes anywhere from five to 15 days for symptoms to start after exposure to a virus that causes roseola.

Your child is contagious and can spread roseola to others while they have a fever and for 24 hours after the fever goes away. A fever is a temperature of 100.4 degrees F (38 degrees C) or higher. So, even if your child seems alert and fine, avoid sending them to daycare or play dates until they’ve kept a normal temperature for at least 24 hours. They can’t spread roseola if they only have a rash.

Talk to your pediatrician if you’re unsure about whether your child can safely be around others. It’s especially important to avoid contact with children who have a compromised immune system. That’s because roseola can cause more serious complications for them.

Can you get roseola twice?

It’s possible to get roseola more than once, but it’s rare. Usually, children develop immunity to roseola once they have it, so they’re unlikely to catch it again. However, children or adults who are immunocompromised may develop roseola more than once.

What are the complications of roseola?

Most children have no complications. However, among those that do, the most common issue is a febrile seizure. Febrile seizures affect 10% to 15% of children 6 to 18 months old who have roseola, typically on the first day of their fever.

These seizures usually last fewer than 15 minutes and cause no lasting harm to your child. The three main signs of a febrile seizure include:

• Your child’s body shakes, stiffens or tenses up.
• Your child passes out, or their eyes roll back in their head.
• They lose control of basic body functions and suddenly vomit, drool, pee or poop.

Call 911 or your local emergency number if your child shows these signs and has never had a febrile seizure before. Don’t try to treat a first-time febrile seizure at home. Your child needs immediate medical care to make sure they’re not having a more serious type of seizure.

If your child has had febrile seizures before, your pediatrician will tell you how to handle them if they occur again. Be sure to follow their guidelines closely. When in doubt, call for emergency help.

Be sure not to exceed the recommended doses and frequency for acetaminophen or ibuprofen to try and prevent a febrile seizure. Overdoing these medications can lead to liver damage/failure (too much acetaminophen) or kidney damage/stomach problems (too much ibuprofen).

Children rarely have more serious complications from roseola. However, they can occur, especially for children who have weakened immune systems due to cancer, autoimmune disease or other conditions. Possible complications include:

• Infection and inflammation in their lungs (pneumonia).
• Inflammation of the delicate layer of tissue surrounding their brain and spinal cord (aseptic meningitis).
• Inflammation of their brain (encephalitis).
• Other conditions affecting their brain or spinal cord, which make up their central nervous system.

How do healthcare providers diagnose roseola?

Healthcare providers diagnose roseola by talking to you about your child’s symptoms and doing a physical exam. Children rarely need blood tests or other tests to confirm a diagnosis. Your pediatrician will rule out other causes of your child’s symptoms, including:

• Allergic reaction to a medication.
• Ear infection.
• Measles.
• Rubella.
• Scarlet fever.

Your pediatrician will tell you how to manage your child’s fever and when you should seek medical care.

What is the treatment for roseola?

You can usually treat roseola at home by giving your child medicine to reduce their fever and keeping them comfortable. Here’s what to know about roseola treatment:

• Healthcare providers don’t have a specific treatment for roseola.
• Antibiotics won’t help since they treat bacterial infections, not viral infections (and roseola is a viral infection).
• You won’t need to treat the rash because it doesn’t itch or cause pain.
• Your pediatrician may recommend children’s acetaminophen or ibuprofen to reduce your child’s fever.
• You shouldn’t give aspirin to a child under age 17 due to the risk of Reye’s syndrome.
• If your child is taking immunosuppressant medication, ask your pediatrician if any special treatment is needed.

If you have any questions about managing roseola, talk to your pediatrician. They’re happy to answer your questions and explain how best to help your child.

Can roseola be prevented?

Roseola is unavoidable for most kids. There’s no vaccine for it, and most children get it before starting school. However, you can help your child stay healthy by helping them develop good hand-washing habits. Hand-washing is one of the best ways to prevent viral infections. Your pediatrician can offer additional suggestions.

What can I expect if my child has roseola?

Some children are alert, want to play and seem like their usual selves when they have roseola. Others may be restless or irritable, especially when their fever is high. Most babies and children recover in about one week and don’t have any complications. However, be aware that febrile seizures are a possible complication.

If your child has a medical condition that weakens their immune system, talk to your pediatrician about what to do if they develop a fever. Your pediatrician will offer guidance on signs of complications and when to call for help.

How do I take care of my child?

It’s never easy to see your child feeling sick. Try not to worry too much, and know that roseola is common and usually harmless. Stay in touch with your pediatrician for any questions or concerns. Here are some things you can do at home to help your little one stay comfortable:

• Dress your child in lightweight clothing while they have a fever and avoid heavy blankets.
• Give your child medicine to help lower their fever. Ask your pediatrician for guidance about the specific types to use and the dosages.
• Encourage your child to drink enough fluids to stay hydrated.

When should I call my pediatrician?

Call your pediatrician if your child:

• Has a fever of 102 degrees F (39 degrees C) for 24 hours (even if they have no other symptoms).
• Seems unwell or isn’t acting like their usual self after the fever is gone.
• Has a febrile seizure (and has had them before).
• Has a rash that’s itchy or painful.
• Has signs of dehydration, such as dry tongue and lips and no tears when crying.

Roseola can affect some children differently based on their medical needs. Call your pediatrician right away if your child spikes a fever and has:

• A weakened immune system.
• A heart condition.

Children with these conditions may respond differently to a fever and its effects on their body. Your pediatrician will offer guidance on what you should do.

When should I seek emergency care for my child?

Call 911 or your local emergency number if your child shows signs of a febrile seizure and has never had one before.

You should also seek emergency care for your child if they have:

• A febrile seizure that lasts five minutes or more, regardless of whether they’ve had one before.
• Difficulty breathing or other signs of pneumonia.
• A weak or high-pitched cry that sounds different than usual.
• Symptoms of an infection in their brain or spinal cord. Such symptoms include stiffness or pain in their neck, frequent vomiting and a lack of energy or interest in what’s going on around them.

Does roseola mean you have herpes?

Two viruses that can cause roseola (human herpesvirus 6 and human herpesvirus 7) are part of the family of herpes viruses. However, they don’t cause cold sores or genital sores, which happen due to the herpes simplex virus.

Is it possible to have roseola and not know it?

Yes. It’s possible that your child (or you as a child) had a virus that causes roseola without knowing it. Kids get fevers for lots of reasons. If your child doesn’t get a roseola rash, you may chalk up the fever to some other illness and never know your child had roseola.

A note from Cleveland Clinic

When your child suddenly gets sick, it’s normal to worry about them and wish you could instantly make things better. There’s no magic wand you can wave to make roseola disappear right away. It has to run its course, but it usually doesn’t last longer than a week. The good news is that the rash doesn’t itch or cause your child any pain, and it’s a sign their fever is gone.

Most kids recover just fine from roseola. But febrile seizures are a possible complication. So, keep a close eye on your child, especially when their fever is high. If your child has a weakened immune system, seek guidance from your pediatrician. They’ll help you know the signs of complications to look out for and when to seek further care.