Roseola

Roseola is a childhood illness with fever, runny nose and irritability followed by a rash. It's caused by a virus, in the human herpes virus family.

Roseola can be uncomfortable but not serious. Most children in Aotearoa New Zealand have roseola between 6 months and 3 years of age. It's spread by saliva. It takes 9 to 10 days after infection for symptoms to start – this is called the incubation period. It's no longer infectious 24 hours after the fever goes.

Afterwards you are usually immune for the rest of your life, though rarely you can have it a second time or have it as an adult. There's no vaccine against roseola. 

• High fever (often up to 40^o C) for 3–5 days.
• Upper respiratory symptoms, eg, a sore throat, cough, runny or blocked nose.
• Irritability and tiredness.
• Loss of appetite.
• As the fever gets better, a rash appears around days 3 to 5. The rash:
  • looks like small rose-pink or red raised spots (2–5 mm across) that blanch (turn white) when touched
  • may have some spots surrounded by a lighter halo of pale skin
  • is mainly on the chest, back and tummy (puku)
  • rarely spreads to the neck, face, arms and legs
  • can be inside the mouth
  • spots aren’t painful or itchy and they don’t blister
  • can fade within a few hours or last for as long as 2 days.

Many children with roseola are not very sick. Sometimes a child can have the virus and never develop the rash. Less commonly, the rash may appear without a fever beforehand. In younger children high fever can trigger febrile seizures.

The roseola rash can look like measles. The difference is that the measles rash starts on the head, and a child with measles seems very sick.

The image shows a roseola rash on a baby's back.

 Image credit: DermNet NZ

Diagnosis

Your healthcare provider can diagnose roseola by talking with you about your child’s symptoms and looking at the rash.

Care at home

Your child’s own immune system will get rid of the virus in about a week, so no specific treatment is needed. Care is aimed at helping your child feel comfortable, so you can:

• Give them lots to drink.
• Let them rest.
• While they have a fever, use only light clothes and bedding and open a window or use a fan.
• Use paracetamol or ibuprofen. You can use our paracetamol dose calculator or ibuprofen dose calculator to make sure you're giving them the right amount. 

No treatment is needed for the rash.

Can my child go to childcare?

If your child has a fever or is unwell they are best cared for at home. If your child is not needing extra care, and if the rash has been confirmed to be roseola by a healthcare provider, then they can go to childcare.

When to seek urgent help

Complications are very rare, but see a doctor urgently if your child:

• is unable to drink
• is confused even after they have had paracetamol or ibuprofen
• can’t be woken up.