Fifth Disease-Viral Rash

Is this your child's symptom?

  • Viral rash that starts with red cheeks and spreads to the shoulders

Symptoms of Fifth Disease

  • Bright red cheeks on both sides for 1 to 3 days. Looks like "slapped cheeks".
  • Followed by pink "lace-like" (net-like) rash of arms and legs.
  • "Lacy" rash mainly is on thighs and upper arms/shoulders.
  • Rash also is on chest and stomach in 50% of children.
  • The rash does not itch or hurt.
  • No fever or low-grade one less than 102° F (39° C).
  • Peak age: 4 -12 years.

Cause of Fifth Disease

  • It is caused by the human parvovirus B19.
  • Not related to the dog parvovirus.

Prevent Spread to Others

  • Good hand washing can prevent spread of this illness.
  • Once the rash occurs, the child can no longer spread the virus.

When to Call for Fifth Disease-Viral Rash

When to Call for Fifth Disease-Viral Rash

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Only 1 cheek is red and also has fever
  • High Risk child (such as those with a chronic medical problem or weak immune system)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever higher than 102° F (39° C)
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Sore throat lasts more than 48 hours
  • Mother or other caregiver is pregnant
  • You have other questions or concerns

Self Care at Home

  • Fifth disease suspected

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Only 1 cheek is red and also has fever
  • High Risk child (such as those with a chronic medical problem or weak immune system)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever higher than 102° F (39° C)
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Sore throat lasts more than 48 hours
  • Mother or other caregiver is pregnant
  • You have other questions or concerns

Self Care at Home

  • Fifth disease suspected

Care Advice for Fifth Disease

What You Should Know About Fifth Disease:

  • It is a viral rash that is harmless.
  • It does not itch or hurt.
  • It can be treated at home.
  • Here is some care advice that should help.

Fever Medicine:

  • For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Note: fevers less than 102° F (39° C) are important for fighting infections.
  • For all fevers: keep your child well hydrated. Give lots of cold fluids.

Pregnant Women - Special Risk:

  • The risk of Fifth disease is to the unborn babies of pregnant women. It is not harmful to the woman herself.
  • A pregnant woman should see her doctor if she is exposed.
  • He will do a test to see if the mother has had the disease. If she has, she is protected.
  • If not, the pregnancy will need to be watched closely. Some babies that get it before birth can have problems. Ten percent can have a very low red blood cell count and 2% may die.
  • But, birth defects are never a result of this virus.

What to Expect:

  • The lace-like rash can come and go for 1 to 3 weeks.

Return to School:

  • Once your child has the "slapped cheeks," they can no longer spread the illness. Also, the lacy rash cannot be spread to others either.
  • Your child does not need to stay home from child care or school.
  • It can be spread during the week before the rash begins.
  • Exposed children should try not to have any contact with pregnant women. This may be hard to know ahead of time.

Call Your Doctor If:

  • Fever higher than 102° F (39° C) occurs
  • You think your child needs to be seen
  • Your child becomes worse

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC. Date Updated: Mar 31 2025 13:32 Version 0.1

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starfish
February 12, 2026
There are cases of measles in NC, and we are aware of exposures in Chapel Hill, Durham, and Wake County. We can give the MMR dose early to families who want it. This applies to infants 6-12 months who have not gotten a dose yet or kids under 4-5 years who have not gotten their second MMR dose. At this time, the NC DHHS and health departments are not recommending this unless traveling or living in an area with sustained transmission. 2 doses of the MMR vaccine are highly effective (97%) at preventing measles infections. At CHCAC, children receive their first dose at 12 months of age and a second dose at 4 years of age, ensuring they are fully protected as soon as possible, in accordance with the most up-to-date AAP recommendations. Some infants aged 6 months to 11 months who travel internationally or in high-prevalence areas may need a dose to protect them; however, they still require the 1-year and 4-year-old doses as well. If you are ever concerned about a possible exposure to measles, please CALL before entering our office. DO NOT ENTER the office. NC DHHS keeps a list of areas with measles exposures here . This is a highly contagious illness, and special precautions must be taken to prevent spread. The virus can be present in the air for 2 hours after an infected person is in the room, and 90% of susceptible patients can be infected. As always, if you have questions, we are here to help make sense of it all!
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