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RASHES  IN  BABIES  AND  CHILDREN

 

A rash on a baby or child rarely indicates a serious problem, but occasionally it is a warning sign.

 

• Rashes can be caused by allergic reactions or by infections. In most cases, allergic reactions are harmless, but when a rash is the result of an infection it can be a warning sign of a serious condition - especially if the infection responsible is meningitis. 
• It is sensible to learn to distinguish harmless rashes from dangerous ones, taking into account other symptoms, although you should always consult your doctor immediately if you are in any doubt. 
• If the rash is caused by infection, you may also need to consider whether isolation is necessary. 

A child's rash caused by an infection may require an incubation period ­consult your doctor to get a proper diagnosis.

 

Recognizing  childhood  rashes

 

It is generally impossible to take one look at a rash and know at once what it means. Rashes can erupt due to a variety of causes ranging from the raised temporary weals caused by stinging nettles to the purple spots associated with life-threatening meningitis. However, many of them have particular distinctive features that give clues to the problem.

 

Chickenpox This condition usually starts with a mild fever, headache and sore throat, with small raised red spots appearing on the head or upper body. The spots become fluid-filled and are extremely itchy and inflamed. Over a few days, the fluid in the spots becomes cloudy and they eventually crust over to form scabs

 

Rubella Also known as German measles, the initial symptoms of this viral illness are a mild fever and swollen glands behind the ears, leading to a rash on the second or third day after infection. The rash consists of multiple tiny flat spots that eventually blend together to give a red 'blush' to the skin.

 

Meningitis and septicemia These are serious infections. Purple-coloured blotches may appear, which do not fade when pressed with a glass. In early meningitis, the rash can resemble that of measles, rubella or roseola and may turnwhite during the glass test. Other symptoms are a high temperature, vomiting and neck stiffness.

 

 Measles is a viral infection that causes a lung infection and a non-itchy brown pink rash about three days into the illness. There are also severe cold­ like symptoms. Typically, the rash starts behind the ears and then affects the face and upper body. The rash consists of both raised and flat red patches on the skin that can be up to 2cm (%in) in diameter. Small white spots, known as Koplik's spots, can also develop on the tongue.

 

Roseola infantum this illness causes a rapid temperature rise - somewhere between 39.5°C (103°F) to 41°C (106°F) - with swollen glands. As the temperature returns to normal, a pink rash with flat spots appears, first on the trunk and then spreads to the neck, arms and thighs. The flat spots turn white when the skin is pressed with a glass, which can also happen in early meningitis

 

Urticaria this type of rash is usually caused by an allergy or a localized skin reaction to, for  example, a nettle sting. It often develops very suddenly. The rash can be recognized by its  distinctive irregularly shaped raised weals, which are surrounded by an inflamed red area. In a serious allergic reaction, urticaria may be accompanied by difficulty breathing and swelling of the face, particularly the lips and around the eyes.

 

When to call the doctor

 

Seek urgent medical advice without delay in any of these situations. 

1.  If you suspect meningitis (see box below) or measles (see previous page). 

2.  If your child has a high fever - over39.5°C (103°F) - or has a febrile convulsion. 

3.  If your child (especially a baby under nine months) has been unwell for over 48 hours with no sign of improvement. 

4.  If your child develops a rash and becomes rapidly unwell with a fever of 37.8°C (100°F) or more. 

5.  If your child repeatedly vomits and/or complains of a headache. 

6.  If you suspect an infectious disease (so that contact with any vulnerable patients in the surgery can be avoided). 

7.  If your baby is floppy or unresponsive

 

Meningitis and septicaemia

 

Meningitis is an extremely serious infection to which children under five are particularly vulnerable. Septicaemia or blood-poisoning may occur alongside meningitis.

 

• Meningitis can be caused by either a viral or bacterial infection and at first the symptoms are similar. Viral meningitis is the most common type and is rarely serious. It usually follows an infection such as influenza, chickenpox, measles or mumps. 
• Bacterial meningitis is rare and the most dangerous - it can be fatal. However, with early diagnosis and treatment, most children go on to make a full recovery. 
• Symptoms include a high-pitched cry; refusing food; vomiting; fever; difficulty in waking; being floppy and lethargic; having bulging fontanelle; neck stiffness. These are common to many childhood illnesses, but in meningitis the child's condition deteriorates rapidly.
• A rash can develop at any time, although it does not always do so and anywhere on the body. The skin is pale and blotchy with a pin-prick, purple-red rash that turns into bruise-like blotches. 
• The rash caused by meningitis is unique but does not always appear when the disease strikes. If a rash appears anywhere on the body, press the side of a clear glass against it. If its colour does not fade, get urgent medical help so that antibiotics can be given without delay. 

Hold a glass firmly against your child's skin - if the rash does not fade, you should suspect meningitis.

 

Allergic rashes

Allergic rashes occur when the skin comes into contact with an irritant or something to which a child is allergic.

 

• Any rash that appears on your child's skin as the result of contact with an irritant, such as a chemical in biological washing powder, baby wipes or soap, is known as contact. dermatitis. 
• The rash is usually red, lumpy and itchy and localized to the area of contact but otherwise the child should be well. Soothing creams are all that is usually required. 
• Nappy rash, a form of contact dermatitis, is a common problem in babies under two. Clean your baby frequently and leave the nappy area open to the air as much. as possible. Use barrier creams to reduce skin contact with irritants. 
• Sometimes a nappy rash can become infected with thrush. The skin becomes bright red and there are white and red pimples. It can be treated with an anti-fungal cream. 

Hives is a common allergic skin complaint - nettle rash is a. form of hives. It produces red weals that eventually become white with a red rim. These can itch and sting, but the child is otherwise well. Usually they disappear within 24 hours so long as the cause of the reaction has been removed. Treat with a soothing antihistamine cream.

 

To prevent and treat nappy rash in your baby, apply barrier cream over the area after every nappy change.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.