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Rashes and spots in children: common causes and when it is an emergency

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Fever with spots that do not fade when pressed with a glass
  • Purple spots that look like bruises
  • Hives with swelling of the lips, face or tongue, or trouble breathing
  • Your child seems very ill, very listless or hard to wake
  • Widespread blisters or peeling skin
  • A seizure with fever

Help lines:

Warning signs: when to go to the ER

Most rashes in children come from viruses, eczema, diaper rash or insect bites, and they are not serious. Do the glass test: if your child has a fever and spots that do not fade when you press a clear glass on them, go to the ER. Call 911 for hives with swollen lips or trouble breathing.

  • Viral rash — small pink spots with a cold; fade on their own
  • Roseola — high fever for a few days, then a rash as it drops
  • Hand, foot and mouth disease — mouth sores and spots on hands and feet
  • Chickenpox — itchy blisters that turn into scabs
  • Eczema — dry, red, itchy skin in folds
  • Diaper rash — red skin in the diaper area
  • Allergy or hives — raised itchy welts; urgent if there is swelling

The glass test: when a rash is an emergency

Press the side of a clear drinking glass firmly against the spots. If you can still see the spots through the glass and they do not fade, and your child has a fever or seems unwell, go to the ER right away. Purple spots that look like bruises are a warning sign.

Call 911 if your child has hives with swollen lips, face or tongue, or is struggling to breathe or swallow.

Rash in children: warning signs by age

We do not see babies under 6 months by video. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher is an emergency, rash or no rash. If the rash comes with a fever, also read fever in children.

  • 6 to 12 months: go to the ER if, along with the rash, your baby has a weak, high-pitched or nonstop cry, a bulging soft spot, or fewer than 6 wet diapers a day and seems listless.
  • 1 to 5 years: go to the ER for a fever with spots that do not fade under a glass, if your child is very listless, or is barely peeing and has sunken eyes.
  • 6 to 17 years: go to the ER for a fever with a severe headache and stiff neck, or hives with shortness of breath. A rash with fever, belly pain or bleeding gums can be dengue.
  • Any age: get seen in person if a fever lasts 5 days or more, especially with red eyes, cracked lips or swollen hands and feet.

Common causes of rashes in children

The causes table on this page sums up the usual ones:

  • Viral rashes: small pink spots on the body that come with a cold or other infection and fade on their own.
  • Roseola: common between 6 months and 1 year. A high fever for a few days, then a rash appears as the fever drops.
  • Hand, foot and mouth disease: fever, mouth sores and spots or small blisters on the hands and feet. See hand, foot and mouth disease.
  • Chickenpox: a rash that turns into itchy blisters and then scabs, starting on the chest, back and face. It is usually milder in vaccinated children.
  • Eczema: dry, red, itchy skin, often in skin folds. See eczema and dermatitis.
  • Diaper rash: red skin in the diaper area from moisture, stool or yeast.
  • Impetigo: oozing sores that form a honey-colored crust.
  • Insect bites and allergic hives.

Diaper rash: home care

Change the diaper often, as soon as your baby pees or poops, let the skin air-dry, and apply a zinc oxide or petroleum jelly product to clean, dry skin. Get it checked if the rash gets worse or does not improve in 2 to 3 days, spreads outside the diaper area, has blisters, sores or pus, or if your baby has a fever.

Home care for other rashes

If your child looks well and has no warning signs:

  • Lukewarm baths with a mild soap; pat dry.
  • Fragrance-free moisturizer for dry skin or eczema.
  • Short nails so scratching does not break or infect the skin.
  • Light, loose cotton clothes; leave the skin open to the air when you can.
  • For fever or discomfort, acetaminophen or ibuprofen dosed by weight. Never give aspirin.

How to show your child's skin on a video visit

Find a spot with good natural light, bring the camera close to the rash, then pull back so the doctor can see the whole area. For private areas such as the diaper area, the doctor will tell you what to show, and the parent or guardian is present the whole time. Visits are not recorded.

Do not send photos of your child's skin by WhatsApp or email. See how to prepare your child for the visit.

When can a video visit help with a rash?

An online doctor visit can help with common rashes in children 6 months or older who look well: eczema, diaper rash, hives without other symptoms, a small patch of impetigo, hand-foot-mouth or bites. The doctor will assess what she sees. If appropriate, the doctor can prescribe medication, dosed by weight. We do not prescribe controlled substances.

The doctor is a general practice physician and is not a pediatrician. She will assess whether the rash needs to be touched, tested or seen by a pediatric or dermatology specialist. See the child doctor visit. For adults, read skin rash.

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Frequently asked questions

How do I know if my child's rash is serious?
Do the glass test: with a fever, spots that do not fade when pressed with a clear glass mean go to the ER. It is also urgent if there is swelling of the lips or face, trouble breathing, or your child seems very ill.
Why did my baby get a rash after the fever went away?
It may be roseola, a common viral infection between 6 months and 1 year: a high fever for a few days, then a rash as the fever drops. If you are unsure or your baby seems unwell, get them checked.
Can the doctor look at my child's rash over video?
Often, yes, with good light and the camera close up. If the skin needs to be touched or tested, the doctor will tell you your child needs an in-person visit.

Sources

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