Rashes in babies and children
A rash on a child almost always frightens more than it deserves: the vast majority are harmless and clear up on their own.
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On this page
- The rash that does not fade under a glass
- When to call for help even without a rash
- Swollen lips and tongue with hives means anaphylaxis
- Rashes of the first weeks of life
- Atopic dermatitis and the skin under the nappy
- Viral rashes: roseola, slapped cheek, chickenpox
- Scarlet fever, measles and Kawasaki disease
- Impetigo, scabies and when a child must stay off nursery
- Online consultation
Medicines commonly prescribed for Rashes in babies and children
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: CREAM, 0.1% w/w betamethasone / 100 gActive substance: betamethasoneManufacturer: Industrial Farmaceutica Cantabria S.A.Prescription requiredDosage form: NAIL POLISH, 80 mg/gActive substance: ciclopiroxManufacturer: Isdin S.A.Prescription requiredDosage form: CREAM, 1 mgActive substance: betamethasoneManufacturer: Galenicum Derma S.L.U.Prescription required
A rash on a child almost always frightens more than it deserves: the vast majority are harmless and clear up on their own. But there are a few situations in which the look of the skin or the state of the child means "right now", and those are worth knowing before they happen. So this page starts with what cannot be waited out, and leaves the common and the harmless until later.
The rash that does not fade under a glass
Take a clear glass and press it firmly against the rash. An ordinary rash fades under the glass and almost disappears. If the marks stay visible, this is not a rash on the skin but blood under the skin: tiny pinprick spots, or small bruises that have not faded.
A rash that does not fade under a glass in an unwell child is a reason to call an ambulance immediately, on 112. This is how meningococcal infection shows itself, and it moves within hours. Say it plainly to the call handler: "the rash does not fade."
And now the crucial part, the reason this section comes first. That rash appears late, and in some children it never appears at all. It is a sign of the final hours, not the first ones. It cannot be waited for as confirmation: if a child is clearly unwell, you call an ambulance with no rash whatsoever. The pause for "let us see if it becomes clearer" is the commonest reason people arrive too late with this infection.
On brown and black skin the colour is harder to make out, so look where the skin is paler: palms, soles, tummy, the inside of the eyelids, lips and tongue. Blood under the skin also has less urgent causes, but telling them apart is a doctor's job. In that minute a parent has only one task: get help.
When to call for help even without a rash
The state of the child says more than the skin does. Call 112, rash or no rash, if your child:
- is listless or floppy, is hard to wake, or is not responding to you as usual;
- moans monotonously, cries in an unfamiliar high-pitched tone, does not recognise you;
- is breathing fast or with effort, grunting, drawing in the spaces between and under the ribs, or pausing between breaths;
- looks pale, grey, bluish or mottled — on brown and black skin this is easier to see on the palms, soles and lips;
- has cold hands and feet while the body is hot;
- has had a fit;
- cannot bend the neck, screws up their eyes against the light, or in a baby has a bulging soft spot on the head;
- is not drinking, the nappy stays dry for many hours, or crying produces no tears.
Separately: any temperature in a baby in the first weeks of life means seeking help the same day, even if the baby seems settled.
A temperature is easiest to check with a digital thermometer; without one, go by a hot back and chest, sweating and shivering. But remember the reverse rule: the absence of a temperature guarantees nothing. A serious infection, especially in a baby, can run with a normal or even a low temperature.
And the last point. You know your child better than any handbook does. If they are not like themselves in any illness you have seen before, that alone is enough reason to get help.
Swollen lips and tongue with hives means anaphylaxis
Hives look like raised weals of various sizes. They itch, they move from place to place and they usually fade within hours. On its own, hives in children is nearly always harmless: it is set off by recent infections, food, medicines, bites and stings, cold and heat.
It becomes dangerous when swelling joins in. Call an ambulance if your child:
- has swelling of the lips, tongue or face, or a feeling of a lump in the throat;
- has gone hoarse or is struggling to swallow;
- is breathing noisily, wheezily or with difficulty;
- turns suddenly pale, goes floppy, drowsy or faints;
- starts vomiting persistently with tummy pain immediately after eating or taking a medicine.
That is anaphylaxis. While the ambulance is on its way, lay the child down and raise their legs; if breathing is hard, sit them up instead. Do not stand them up or walk them anywhere, because a sudden change of position during anaphylaxis is dangerous. If an adrenaline auto-injector has been prescribed, use it straight away into the outer thigh without waiting for things to worsen; a second dose is sometimes needed. And even if everything settles after the adrenaline, the child still goes to hospital — the reaction can return hours later.
Plain hives with no swelling and no breathing difficulty is simpler: a cool compress, loose clothing, removing the cause and an antihistamine chosen for the child's age.
Rashes of the first weeks of life
A newborn's skin is still settling in, and almost everything that appears on it needs nothing but patience.
- Milia — minute white spots on the nose and cheeks. They come up in the first days and go within a few weeks. Do not squeeze them.
- Erythema toxicum of the newborn — an alarming name for a completely harmless thing: reddish blotches with a small white bump in the middle, on the trunk, face and shoulders; they come and go and clear on their own within a couple of weeks.
- Heat rash — a scattering of tiny bumps wherever the skin sweats: the neck, the creases, the nappy area. There is one cause, which is that the baby is too warm and too wrapped up. What helps is not a cream but coolness: fewer layers, light cotton, a cool bath. It does not spread to anyone.
And now the caveat that matters more than all of the above. All of it applies to a baby who feeds well, sleeps peacefully and wakes normally. In a baby in the first weeks of life, a rash together with a temperature, refusing feeds, unusual sleepiness or blisters on the skin does not belong in "let us wait": that baby is seen by a doctor the same day.
Atopic dermatitis and the skin under the nappy
Atopic dermatitis is the commonest long-lasting rash in children. Dry, rough, itchy patches: in babies on the cheeks and the outer sides of the arms and legs, later in the elbow and knee creases, on the neck and hands. It runs in flares. The main trouble is not how it looks but the itch: it keeps the child awake and they scratch the skin raw.
The foundation of care is not a medicine but moisturising. An unscented emollient is applied generously and regularly, including when the skin looks calm; soap and bubble bath are replaced by an emollient wash; nails are kept short. In a flare a steroid cream is prescribed, and its strength and duration are set by a doctor. The child needs to be seen if the skin starts weeping, becomes covered in yellow crusts or blisters, if the itch is stopping them sleeping, or if the usual routine has stopped working.
Nappy rash looks different: redness on the prominent areas that meet the nappy, while the depths of the creases usually stay clear. What helps is changing the nappy often, time without one, washing with water or with unscented alcohol-free wipes, and a thin layer of barrier cream. Soap, talc and antiseptics only irritate.
If the redness moves into the depths of the creases, becomes vivid, has a scalloped edge and separate small spots around it, or if the usual care is not working, thrush has probably joined in and an antifungal cream is needed. In the mouth, thrush appears as white patches on the tongue and cheeks that do not wipe off easily, and the baby feeds less willingly. A breastfeeding mother and her baby are treated at the same time, otherwise they pass it back and forth.
Viral rashes: roseola, slapped cheek, chickenpox
Most childhood rashes are caused by viruses and clear up by themselves. A few of them are recognisable.
Roseola. A child under two runs a high temperature for three days without looking severely ill; the temperature drops, and only then does a fine pink rash come out on the neck and trunk. The rash means the illness is over. Notice this: for three of the four days there is no rash at all, so a child with a fever has to be judged by their state and not by their skin.
Slapped cheek syndrome, also called fifth disease, starts with bright red cheeks, as though the child had been slapped. A day or two later a lacy, net-like rash appears on the arms and body, which fades and returns for weeks with heat. By then the child is usually well again and no longer infectious. One exception to remember: the infection is dangerous for pregnant women and for people with chronic anaemia or a weakened immune system, so anyone in that position should be told about the contact.
Chickenpox comes out in waves: spots become blisters and blisters become scabs, with all three stages present on the skin at once. Spots can be anywhere, including the scalp and the mouth. What helps is a cool bath, emollients, an antihistamine, short nails and socks on a small child's hands at night; paracetamol is given for discomfort. Aspirin is not given to children and teenagers. Ibuprofen is also usually avoided in chickenpox. Keep the child away from newborn babies, from pregnant women who have not had it, and from people whose immune system is weakened. See a doctor if the blisters turn hot and painful with vivid redness around them, if the child gets worse rather than better once the spots stop appearing, if they are unsteady on their feet or cannot stay awake.
Scarlet fever, measles and Kawasaki disease
Scarlet fever starts not in the skin but in the throat: pain on swallowing, a temperature, enlarged glands in the neck. A day or two later fine firm bumps come out, first on the chest and tummy. It is recognised not by eye but by hand: in scarlet fever the skin turns rough, like fine sandpaper. That matters, because on brown and black skin the change in colour may not show, while the roughness can always be felt. The face stays free of the rash although the cheeks are flushed, and the tongue goes from white-coated to red and bumpy. It is one of the few childhood rashes that really is treated: a doctor and an antibiotic are needed.
Measles begins like a heavy cold: high temperature, cough, red watery eyes, discomfort in the light. Then white spots appear inside the cheeks, and only after that a blotchy rash that spreads down from the face and behind the ears. With measles the child is genuinely ill, not merely "covered in spots". Measles is prevented by vaccination on the national schedule. Ring ahead before going to a clinic: measles spreads exceptionally easily.
Kawasaki disease is rare, but it has to be named. It begins with a temperature that lasts five days or longer and does not respond to the usual measures. Several other signs join it: a rash, often in the nappy area too; red cracked lips and a red bumpy tongue; red eyes without discharge; swollen red hands and feet, with peeling fingertips later on; an enlarged gland in the neck. The child is usually impossible to settle. Untreated, the disease damages the arteries of the heart, and treatment started in the first days prevents that. So a fever on its fifth day with no clear cause is a reason to go back, even if the child has already been seen.
Impetigo, scabies and when a child must stay off nursery
Impetigo is a contagious skin infection, most often around the nose and mouth. It starts as red sores or blisters that burst quickly and dry into golden-brown crusts, like flakes stuck on the skin. It itches and travels easily on the child's hands to other parts of their own skin and to other children. It is treated with an antibiotic ointment, or with medicine by mouth if widespread. While it is being treated: a separate towel and bedding, frequent handwashing, short nails and no picking at the crusts.
Scabies starts not with the look but with the itch: severe, worse at night and enough to wake the child. Then small bumps and fine winding tracks become visible between the fingers, on the wrists, in the armpits and around the waist. In babies and toddlers, unlike in adults, the palms, soles, face and scalp are involved as well. Treatment is a cream or lotion applied over the whole body and repeated after about a week; everyone in the household is treated at the same time, even without symptoms. The itch can carry on for several weeks after successful treatment, and that is not a sign of failure.
What decides the nursery question is not the spots but three things: how the child feels, whether there is a temperature, and whether the illness passes to others. A child stays home with chickenpox until every blister has crusted; with scarlet fever until treatment has started and the fever has gone; with measles for several days after the rash appears; with impetigo until the crusts dry or the treatment takes effect. No exclusion is needed for atopic dermatitis, heat rash, nappy rash, roseola or slapped cheek once the rash is out. The exact periods differ a little between countries and between individual nurseries, so confirm them with a doctor and with the nursery itself.
Online consultation
An online appointment is not the tool for what the first three sections describe: a rash that does not fade under a glass, a listless child, breathing difficulty or swollen lips all need an ambulance, not a message. For everything else it works well, because a rash is exactly the sort of thing a photograph shows.
The doctor will help work out what you are looking at, say whether an in-person examination is needed and how urgently, go through the care of atopic dermatitis and nappy rash, choose products suitable for the age, explain how not to miss dehydration, and answer the nursery question.
To make the conversation useful, prepare for it: photograph the rash in daylight without flash, close up and from further back, and photograph it again if it changes. Note when it all started, what temperature there was, what the child has eaten and which medicines they have had, and whether there was contact with anyone ill. And say plainly whatever it is that worries you.
This material is for information only and does not replace medical advice.
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