Roseola in babies: fever, pink spots and restless nights

Roseola is a mild viral illness in babies: three days of high fever, then a rash of small pink spots as the fever breaks. It clears up on its own. See a doctor right away if your baby is under 3 months old or has a febrile seizure. Here is how to recognize roseola, when it is contagious, and how to get through the night.

What is roseola in babies?

It is a common viral infection in young children, also called exanthem subitum or sixth disease. It is mild in most cases. According to the Assurance Maladie, more than 90% of cases occur before age 2, peaking between 7 and 13 months. Babies under 6 months are protected by their mother's antibodies, and it becomes rare in children older than 4.

Where does the roseola virus come from?

It is caused by a virus from the herpes family: human herpesvirus 6 (HHV-6), sometimes type 7. It is in the same family as the cold sore virus, but the illness has nothing to do with cold sores. It is found in saliva and in secretions from the nose and throat. Many adults carry it with no symptoms at all, so it can infect young children through close contact with family, according to Hôpital de Montréal pour enfants..

What are the symptoms of roseola in babies?

The main symptom is a sudden high fever, followed by pink spots when it drops. The order matters: fever first, then a rash. That is what makes it recognizable.

First, the fever

The temperature spikes suddenly to 39 to 40 °C and usually lasts about three days without dropping, sometimes up to seven. Signs appear 5 to 15 days after exposure, most often in babies aged 6 months to 2 years. The fever is often the only symptom. It may be accompanied by:

• digestive upset;
• irritability;
• slightly puffy eyelids;
• small swollen lymph nodes in the neck.

Many babies stay in pretty good spirits between spikes, even if they eat less.

Then, the pink spots

The temperature drops suddenly and the spots appear. Some cases have no rash at all.

What do the spots look like?

They are pink spots 3 to 5 mm, sometimes slightly raised, on the chest, belly, hips, shoulders and face, then on the arms and legs. They don't itch and need no treatment. They fade within 12 to 24 hours, sometimes one to three days. A warm bath may bring them back for a while. This is nothing to worry about.

How long does it last?

It lasts 4 to 10 days in total, according to Naître et grandir: about three days of fever, then the rash. Once the rash appears, the child recovers within three days, according to the Assurance Maladie..

Can a child get roseola twice?

Usually not: a child who has had it is protected for life, according to Naître et grandir.

Is there a roseola vaccine for babies?

No, there is no vaccine. Handwashing is still the best way to limit spread.

How is roseola spread, and how long is it contagious?

It spreads through saliva, through droplets from a cough or sneeze, and through hands. The child is most contagious during the high-fever phase. The contagious period starts before the first signs and ends when the rash appears, according to Naître et grandir..

Preventing roseola relies on good hygiene. The Assurance Maladie recommends that you:

• wash your hands before and after every contact with the baby;
• throw tissues away right away;
• don't share bottles, pacifiers and cups;
• air out the room every day.

Can my baby go to daycare?

It is better to keep your baby home while they have a fever. Keeping them out is not required. They can go back to daycare as soon as they no longer have a fever and feel well, according to the Hôpitaux universitaires de Genève..

How do you treat roseola?

The goal is to keep your child comfortable, since there is no specific treatment for the virus. Because it is caused by a virus, antibiotics won't help. For viral infections like roseola, the aim is to ease symptoms, not to push the fever down at any cost.

Medications

Some practical tips from the Assurance Maladie, to discuss with your doctor:

• medication isn't always needed below 38.5 °C;
• acetaminophen (paracetamol) is the first choice, and the only option before 3 months;
• one medication is enough: alternating between two is no more effective;
• no aspirin without medical advice, and no pills before age 6.

Doses depend on weight: follow the prescription or ask your pharmacist.

Drink fluids and stay cool

Offer fluids often, even if your child doesn't ask. Don't bundle them too much, but don't strip them completely: they could shiver. Avoid cold baths.

How do you get through the night with a fever?

Fever often makes nights more restless. Keep safe sleep habits and offer fluids each time your baby wakes.

Putting your baby to sleep safely

The Assurance Maladie reminds parents to put babies on their back in a sleep sack that fits, with no duvet, blanket, pillow or crib bumper, in a room kept at 18-20 °C.

Why does sleep get more restless?

Fever speeds up the heart and breathing. In children, the heart rate rises by about 10 beats per minute for each degree, according to one study of more than 21,000 children (Davies and Maconochie, 2009), and 10 to 14 more beats per minute in another study (Thompson et al., 2009). For typical values by age, see our infant heart rate and breathing rate charts..

Read more

Body temperature also changes on its own at night. Our article on the infant thermoregulation during sleep explains what is normal. If the episode follows a vaccine rather than a viral illness, read our article on the baby's sleep after a vaccine..

What does a contactless sensor show on feverish nights?

A sensor placed under the sheet shows how your baby's breathing, heart and movements change on those nights. It tracks breathing rate, heart rate and movements night after night, and compares them with your baby's own 7-day baseline. It can show restless sleep and faster-than-usual breathing and heart rate, with the times they occurred. These dated trends help you describe those nights to your pediatrician.

It does not measure temperature and does not replace a thermometer. It does not diagnose illness. It does not prevent a seizure. It does not replace a visit: if a sign worries you, have a doctor look at it.

What complications can it cause?

Complications are rare: the Assurance Maladie mentions seizures linked to a high temperature and, even more rarely, viral meningitis.

Febrile seizure: what should you do?

Place the child on their side, then see a doctor as soon as the seizure ends. Seizures mostly happen between 6 months and 5 years old, and most last one to three minutes and stop on their own, according to the Assurance Maladie. :

1. uncover the child;
2. place them on their side in the recovery position;
3. once the seizure is over, treat the fever;
4. see a doctor quickly to look for the cause.

When should you see a doctor?

See a doctor whenever you are worried, even if your child seems fine. The Assurance Maladie and the Hôpitaux universitaires de Genève give these guidelines:

• right away for any fever before 3 months;
• quickly for a seizure, trouble breathing, refusal to drink, drowsiness, vomiting or dehydration (dry mouth, fewer wet diapers, sunken eyes);
• if the thermometer reads 40 °C or your child's overall condition gets worse;
• within 24 hours if the temperature stays high for more than three days.

Your doctor will confirm the diagnosis once the rash appears: it is the rash that marks a case of roseola.

What is the difference between measles and roseola?

The course is different. With roseola, the fever is often the only symptom and drops as the rash comes out, first on the trunk. With measles, according to the Assurance Maladie, it comes with a runny nose, red eyes, a cough and marked fatigue. The rash appears three to four days later, first on the face and behind the ears, and the child stays feverish. Against measles, the MMR vaccine is mandatory for babies, given at 12 months and again between 16 and 18 months.

Roseola in babies: the key points

A mild episode, even if it looks scary: it clears up on its own within a few days, in toddlers as well as in young babies.

• Three days of high fever, then pink spots once it drops.
• Mostly between 6 months and 2 years.
• Contagious before and during the fever, but no longer after the rash appears.
• No antibiotics: acetaminophen (paracetamol) if your child is uncomfortable, and offer fluids often.
• At night: on their back, in a sleep sack, without too many layers, in a room at 18-20 °C.
• Get medical help right away before 3 months, for a seizure, or if anything worries you.