Childhood rashes hard to diagnose at first

Originally published in The Ottawa Citizen October 15, 2002
Original Title: Daycare Part III: A little red in the face

Part I – Why children fight one cold after another
Part II – Children’s eye diseases spread quickly

What are the common childhood rashes seen in the school and daycare setting? Initially, many rashes can look the same, which can sometimes make identification difficult. Rashes eventually branch off in their own direction within a day or two prompting the doctor to say “Aha! I knew what it was happening all along!” This is something akin to what your investment broker says to you now.

Roseola is a viral rash usually seen in children between six and 24 months of age. These children do not appear ill but can have a low-grade fever for a few days. In rare cases, children can develop high fever and febrile seizures. Once the fever breaks, the rash appears as small red spots scattered on the face and body that last a day or two. It is not very infectious and there is no specific treatment.

Hand, Foot and Mouth disease most often affects young children but can appear at any age. It is an infectious viral illness spreading from person to person by air or touch. It occurs more commonly in the summer and fall. It will incubate for ten to 14 days before the start of symptoms. Although usually not severe, it does cause fever, headaches, loss of appetite, diminished activity and energy levels, sore throat and a particular rash.

Small red spots with a blister on top appear on the hands and feet and sometimes on other body parts. There can be painful mouth ulcers. The rash lasts seven to ten days. Children remain infectious one to two weeks after the onset of the illness. There is no specific treatment. Children can return to school or daycare once they feel up to participating in normal activities.

Fifth disease commonly referred to as Slapped Cheeks Syndrome occurs in school-aged children. One to four days before the onset of rash, the child may have had a cold-like illness. Some children will have a headache, sore throat, runny nose, itchiness, nausea, diarrhea and vomiting, joint pain and sore eyes. The range of occurrence of these symptoms runs on average between zero to 50 percent.

It starts as a dark red rash on the cheeks that looks like the face was slapped. By the time the rash develops, the child usually feels better. A rosy red lacy rash appears on the arms and body that can come and go over a period of one to three weeks. There is no specific treatment. They are no longer infectious once the rash appears. Children can return to school when they feel better.

Chicken pox, despite the popular misconception, is not a benign disease. Caused by the Varicella Zoster virus, its complications include skin and soft tissue infection, ear, eye, nose and throat infections, serious bacterial infections like necrotizing fasciitis (“flesh eating disease”), pneumonia, encephalitis and meningitis. In Canada, 2000 children were admitted to hospital last year and 12 died.

Chicken pox has an incubation period of eight to 13 days after viral exposure. It spreads through the air and by direct contact with the blisters.

It starts with a fever for the first two days. Thereafter the classic “fried egg” blisters appear (a red circular spot with a blister in the centre) on the skin. An average of 350 blisters will erupt on the child’s body.

If you think the child has chicken pox or if indeed they do, isolation from pregnant women who have never had chickenpox is important because the virus can damage the fetus. There is no danger to pregnant women who are immune to the virus.

Do not give aspirin (Acetylsalicylic Acid (ASA)) or any products that contain ASA to a child with chicken pox. They can develop Reye’s syndrome that can damage the liver and brain. Use Acetaminophen (Tylenol or Tempra) instead.

Good gentle skin hygiene will help prevent bacterial infections of the pox blisters. Scrubbing the skin can promote infection and scarring. Antihistamines (Claritin, Benadryl) and Aveeno bath powder can help relieve the itch. Calamine lotion is ineffective.

After a chicken pox infection, the virus can lie dormant in the body for years. Once reactivated, it will cause Shingles, a large painful blistered rash on a segment of your body or face with its own set of painful and damaging complications.

What can we do to prevent some of the illnesses reviewed over these past three weeks? Good hygiene and disinfecting toys reduces contagion. However, this is a Herculean task in a room full of toddlers and young children. Some diseases warrant isolating the child during their contagious period. There are vaccines available that can reduce the risk of some of these diseases.

Varivax will protect children from chicken pox. Over 20 million doses and 28 years of experience show long-lasting immunity. Ninety-five percent of children will become immune six weeks after vaccination.

Prevnar will reduce the rate of ear infections and pneumonia caused by the bacteria Streptococcus pneumoniae. It is the most common cause of ear infections, pneumonia and meningitis in infants and toddlers. Menjugate vaccine will protect children from another type of meningitis.

All children that follow the routine vaccination schedule receive the Pentacel vaccine. One component of it protects infants and children against the bacteria Hemophilus influenzae that causes ear infections and pneumonia.

Your doctor can provide more information on your next well-child visit. The only thing infectious in your child should be their smile. May they all be happy and healthy.


© Dr. Barry Dworkin 2002

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