My oldest son had roseola when he was about 18 months old. The fever was extremely high and he was actually hospitalized, had several tests, and finally he broke out in a rash. I felt kind of dumb as a nurse (I had never heard of the disease) but when the doctors were also puzzled, I didn’t feel so stupid and I was glad they took full precautionary measures. Also referred to as the sixth disease, or roseola infantum, the disease is usually a harmless illness caused by a virus. It occurs almost only in children age 3 months to 3 years, most often between 9-12 months. It is probably the most common cause of fever in this age group. This virus generally causes 3 days of high fever (often over 103). The fever then subsides, and the child breaks out in a flat or bumpy red rash, usually starting around the neck, back and chest, then spreading out. The rash lasts a few days to a couple weeks.
Roseola is about the only virus in which the rash appears after the fever breaks. The characteristic of roseola is that infants don’t seem very sick and act almost well when the fever comes down. Sometimes this virus will cause 3 to 7 days of high fever, with no other symptoms and no rash. Two common and closely related viruses can cause roseola: human herpes virus (HHV) type 6 and possibly type 7. These viruses belong to the same family as the better-known herpes simplex viruses, but HHV-6 and HHV-7 do not cause the cold sores and genital herpes infections that HSV can cause. A child with roseola typically develops a mild upper respiratory illness, followed by a high fever (often over 103° F or 39.5° C) for up to a week. During this time, the child may appear fussy or irritable and may have a decreased appetite and swollen lymph nodes (glands) in the neck. The high fever often ends abruptly, and at about the same time a pinkish-red flat or raised rash appears on the trunk and spreads over the body. The rash’s spots blanch (turn white) when you touch them, and individual spots may have a lighter “halo” around them. The rash usually spreads to the neck, face, arms, and legs.
The fast-rising fever that comes with roseola triggers febrile seizures (convulsions caused by high fevers) in about 10% to 15% of young children. Signs of a febrile seizure include unconsciousness, 2 to 3 minutes of jerking or twitching in the arms, legs, or face and loss of control of the bladder or bowels. Roseola is contagious and spreads through tiny drops of fluid from the nose and throat of infected people. These drops are expelled when an infected person talks, laughs, sneezes or coughs. Other people who breathe the drops in or touch them and then touch their own noses or mouths can then also become infected. The viruses that cause roseola do not appear to be spread by kids while they are exhibiting symptoms of the illness. Instead, someone who has not yet developed symptoms often spreads the infection. It is contagious from about two days before the fever starts until 1 or 2 days after the fever is gone, even if the rash continues. Children who are fever-free for 1 or 2 days can return to school, even if they still have a rash. The incubation period (time from when your child is exposed to the time of actual illness) is around 10 days.
With roseola, or the sixth disease, you essentially treat any symptoms that are bothering your child. There is no actual treatment for this virus. The main thing to keep in mind is that this virus can cause high fevers. Until the fever drops, you can help keep your child cool using a sponge or towel soaked in lukewarm water. Do not use ice, cold water, alcohol rubs, fans or cold baths. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) can help to reduce your child’s fever. Remember not to give aspirin to a child who has a viral illness because its use in such cases has been associated with Reye syndrome, which can lead to liver failure and death. To prevent dehydration from the fever, encourage your child to drink clear fluids such as water with ice chips, children’s electrolyte solutions, flat sodas like ginger ale or lemon-lime (stir room-temperature soda until the fizz disappears) or clear broth. If you’re still breastfeeding, breast milk can help prevent dehydration as well.