Roseola symptoms, signs and treatment

Also known as the sixth disease, exanthema subitum and – in children – roseola infantum, this typically mild viral infection persists for about a week.

M Davis/Wikipedia

Roseola is common in babies and toddlers from the ages of around six months to two years, although it’s not unheard of in older children and adults. Read on to find out more about this disease.

What are the symptoms of roseola?

‘Sometimes a child might have roseola without developing any symptoms,’ says Dr Benjamin Dallyn, who works in Public Health Medicine in South London. ‘In this case you might never know your child had the infection.’

If your child does show symptoms expect a high fever (38°C/100°F or more) as well as a sore throat, cough, runny nose, mild diarrhoea and swollen glands.

The fever, which lasts for three-seven days, is then followed by a non-itchy rash that tends to begin on the stomach, chest and back before spreading to the face, neck, arms and legs. The pinky-red spots turn white when pressed (to check this roll a tumbler over some spots) and last for a couple of days.

Unless there’s an underlying problem most children start to feel better when the rash appears and recover soon afterwards.

Be aware that a high fever can cause a febrile seizure

Some children, usually under the age of three, may experience a febrile seizure (otherwise known as a fit) when they get a high temperature. A seizure causes the limbs to stiffen or twitch and the child may lose consciousness, vomit or foam at the mouth.

Alarming as this is to witness, a febrile seizure is usually harmless and does not cause long-term damage.

The NHS recommends that you call the emergency services if it is your child’s first seizure, if they are struggling to breathe, or if it lasts longer than five minutes.

Emiliano Burzagli/Wikipedia

What are the causes of roseola?

Roseola is caused by two common viruses – human herpesvirus6 and human herpesvirus7 (HHV) – that belong to a larger family of viruses that includes HSV (responsible for cold sores), VZV (causes chickenpox and shingles), and the Epstein-Barr virus (EBV).

Roseola is known as the sixth disease because it is one in a group of half a dozen childhood viral exanthems that feature skin rashes. Other viral exanthems include measles, scarlet fever and rubella. While related, having one of those diseases does not cause another.

However, ‘it can be hard to tell the roseola rash apart from similar rashes caused by more serious childhood illnesses, such measles and rubella. You can protect your child from measles, rubella and other infectious diseases by making sure all of their immunisations are up to date,’ says Dr Dallyn.

Is roseola contagious?

Roseola can be passed on before the fever starts and, most likely, during the fever stage but it isn’t catching by the time the rash appears.

‘It is spread through coughs, sneezes and touching contaminated surfaces but it doesn’t spread very easily, and if your child feels well enough to go to nursery or school then there’s no need to keep them at home,’ explains Dr Dallyn, although some childcare providers and schools may insist that your child doesn’t return until they’re better.

‘To stop the infection spreading, you and your child should wash your hands often; sneeze or cough into a tissue and throw the tissue away immediately; clean household surfaces; and not share cutlery or plates,’ says Dr Dallyn.

How to treat roseola

Because roseola is a virus it won’t respond to antibiotics but it is rarely a serious disease and can be treated with bed rest in a cool room, plenty of fluids including breast milk and electrolyte medication, and pain and fever relief such as children’s paracetamol and ibuprofen.

Although these two drugs shouldn’t be administered at the same time they can be alternated every four hours.

‘Always use medicines according to the instruction leaflet,’ warns Dr Dallyn, and don’t give aspirin to a child with a virus as it has been linked to the potentially fatal Reye’s syndrome.

When should I see a doctor about roseola?

Call a doctor is your child seems very sleepy, lethargic or confused, if they refuse fluids, or if you suspect the illness to be a more serious one such as meningitis or measles.

As babies are more vulnerable to fevers Public Health Medicine advises that babies under three months with a fever of 38°C/100°F or above, and babies between three-six months with a temperature of 39°C/102°F or above, should be seen by a health professional.

If the fever causes a febrile seizure and you are unsure call an ambulance or go to A&E, and if the rash doesn’t improve after three days Dr Dallyn advises that your child is seen by a GP.

Can adults catch roseola?

Because most of us are exposed to such viruses in childhood it’s rare but possible for an adult, including pregnant women, to catch roseola. There are very few instances of being re-infected by roseola and it affecting a foetus so it’s considered low risk for pregnant women to be around an infected child.

If, however, you have a weakened immune system as a result of a serious illness or chemotherapy it may be better to avoid children with the disease.