Scarlet fever

Also called Scarlatina, Group A strep

A sandpaper rash with a sore throat in a child. Antibiotics are genuinely needed here, which makes it an exception among childhood rashes.

What it is

An illness caused by group A streptococcus bacteria, most common in children between two and eight.

Most childhood infections in this library do not need antibiotics. This one does, and that is the reason it has its own entry. Treatment shortens the illness, makes the child non-infectious within 24 hours, and reduces the risk of complications including rheumatic fever and kidney inflammation.

The much rarer and more serious concern is invasive group A strep, where the bacteria reach the bloodstream, lungs or deep tissue. It is uncommon and it is fast, and the UK has seen periodic surges. A child who is getting worse rather than better after starting antibiotics needs re-assessing urgently.

It is a notifiable disease, so a diagnosis is reported to public health. That is routine and is how outbreaks in schools and nurseries are picked up.

Chickenpox raises the risk of an invasive strep infection, so a child who becomes suddenly much more unwell during chickenpox is a specific worry.

Signs you might notice

Sore throat, fever, headache, swollen neck glands, and often being sick.

A rash appearing 12 to 48 hours later: fine, pink-red, and feeling like sandpaper. It usually starts on the chest and tummy and spreads. On brown and black skin the rash is harder to see and the sandpaper texture is the more reliable sign.

Flushed cheeks with a pale ring around the mouth.

A white coating on the tongue that peels to leave it red and bumpy, the strawberry tongue.

Peeling skin on the fingertips and toes in the week or two afterwards.

999 or A and E: a child who is very unwell, floppy, drowsy or difficult to wake; breathing fast or with difficulty; a rash that does not fade under a glass; severe muscle pain; not passing urine; cold hands and feet with a fever. See sepsis and meningitis.

How it can affect day-to-day life

The sandpaper texture is what people remember. Parents often describe knowing the rash was different by touch before they could see anything.

On darker skin the rash is genuinely hard to see, and it is repeatedly missed for that reason. Feel for it, look at the tongue, and do not rely on the redness.

Children can return to school 24 hours after starting antibiotics, which is unusually quick, and finishing the whole course still matters.

Nursery and school outbreaks are common and the setting has a duty to notify.

Adults get it too, particularly parents of infected children, and it is often not considered.

Supporting someone well

See a GP the same day for a suspected case. This is not a wait-and-see illness.

Finish the whole antibiotic course even after the child is better, because the complications are what the full course prevents.

Fluids, paracetamol or ibuprofen at the right dose for weight, and soft cool food for a painful throat.

Keep away from nursery or school for 24 hours after antibiotics start, and tell the setting.

Wash hands, do not share cups, towels or cutlery, and wash bedding.

Go back urgently if the child is not improving within a day or two of antibiotics, or gets worse. That is the invasive infection pattern.

Be especially watchful if the child also has chickenpox.

Where to get help

A GP practice the same day, or NHS 111 out of hours.

999 or A and E for the emergency signs above.

Meningitis Now and the UK Sepsis Trust both publish the child warning signs in a form worth keeping on a fridge.