Fever with Rash in a Child: What to Check First
Press the rash firmly with a clear glass. If it fades under pressure, the rash is unlikely to be the dangerous, non-blanching kind, though a few blanching rashes such as scarlet fever still need a doctor. If it stays visible through the glass, call 995 (Singapore's emergency number) now. Most fever rashes are viral and not dangerous, but a non-blanching rash is a medical emergency.
The blanch test
The first thing to do when you notice a rash with fever is the blanch test. It takes about ten seconds and tells you immediately whether the rash needs emergency care.
The side of a drinking glass works. You need to see through it while pressing.
Hold the glass flat against the skin over the rash and press firmly for a few seconds.
Keep pressing and look at the rash through the glass. Does it fade or disappear under the pressure?
The dangerous non-blanching kind is unlikely. Check the common rash patterns below: most need no treatment, but a few, such as scarlet fever, still need a doctor.
Call 995 immediately. Do not wait to see if it spreads or changes.
Non-blanching rash
A rash that does not fade under pressure means blood has leaked into the skin. This can be caused by meningococcal disease or other serious bacterial infections that can worsen within hours. The spots may look like small pin-pricks (petechiae) or larger bruise-like blotches (purpura). They are often dark red or purple.
Call 995 if the rash does not fade under the glass
- !A non-blanching rash with fever is a medical emergency
- !Do not wait to see if the spots spread. Act immediately.
- !Do not wait for your child to seem more unwell
- !Call 995 and describe the rash while you wait for the ambulance
Note that the non-blanching rash is often a late sign of meningococcal disease. Earlier warning signs that should prompt emergency care even before a rash appears include a stiff neck, extreme drowsiness or difficulty waking, sensitivity to light, or severe headache alongside a high fever.
Common rashes with fever
The large majority of rashes in feverish children are viral, blanch under pressure, and need no specific treatment. A few need a doctor visit.
High fever for 3 to 5 days, rash appears as fever breaks
Pink or red flat spots on the trunk, spreads to neck and limbs
No treatment needed. Confirm rash blanches. Child usually improves quickly once the rash appears.
Rash alongside or after fever from many common viruses
Pink or red blotchy patches, can be anywhere on the body
No treatment needed. Manage fever for comfort. See a GP if rash is spreading rapidly or child seems very unwell.
Sore throat and fever followed by rash, usually starting on neck and chest
Sandpaper texture, rough to the touch. Skin looks flushed.
Needs antibiotics. See a GP. Do not wait: untreated scarlet fever can have complications.
Can appear quickly alongside or separate from fever
Raised, itchy welts, varying in size, skin around them may be pale
Give an antihistamine. Go to A&E if breathing is affected, or if face or lips are swelling.
Other warning signs with any rash
Even with a blanching rash, seek medical assessment if your child has any of these:
- Stiff neck: cannot touch chin to chest, or resists the movement.
- Extreme drowsiness or unusual difficulty waking.
- Sensitivity to light.
- Rash is spreading rapidly or new spots are appearing quickly.
- Swelling of the face, lips, or tongue. Go to A&E now.
- Breathing difficulty. Call 995.
- Child seems very unwell beyond what the fever alone would explain.
→ Febrile seizure in a child: what to do
→ Fever in a baby under 3 months: what to do
→ Toddler fever 39°C: when to monitor vs seek help
→ What happens when you take a feverish child to A&E
→ Dengue fever in children: symptoms and warning signs in Singapore
Frequently asked questions
How do I do the blanch test?+
Press the side of a clear glass firmly against the rash and hold for a few seconds. Look through the glass while pressing. If the rash fades or disappears, it is blanching, which rules out the most dangerous cause. Most blanching rashes are harmless, but check the common rash patterns below, since a few, such as scarlet fever, still need a doctor. If the rash stays red or purple and remains clearly visible through the glass, it is non-blanching. Call 995 immediately.
My child's fever broke and now they have a rash. Should I worry?+
This pattern is classic roseola: high fever for several days, then a rash appearing as the fever breaks. It is common in children under two, caused by a virus, and usually harmless. The rash is pink, blanches under pressure, and fades within a day or two. Do the blanch test to confirm, and if your child seems well, this is likely just the end of the illness.
My child has spots that do not fade under the glass. What do I do?+
Call 995 now. A non-blanching rash with fever can indicate meningococcal disease or another serious bacterial infection. These conditions can worsen rapidly. Do not wait to see if the spots spread or for your child to seem more unwell. Act immediately.
Can meningococcal disease start without a rash?+
Yes. The rash is actually a late sign, often appearing only after the child is already seriously unwell. Earlier warning signs include a stiff neck, extreme drowsiness or difficulty waking, sensitivity to light, and severe headache. Any of these alongside a high fever needs urgent assessment, even if there is no rash yet.
My child has hives. Is that an emergency?+
Hives (raised, itchy welts that blanch) are usually an allergic reaction and harmless on their own. Give an antihistamine if your child is uncomfortable. Go to A&E immediately if hives come with swelling of the face or lips, difficulty breathing, or a child who seems suddenly very unwell. That is anaphylaxis and needs emergency care.
Which rash with fever needs antibiotics?+
Scarlet fever does. It produces a sandpaper-like rash (rough to the touch) that starts on the neck and chest, usually after a sore throat and high fever. The rash blanches. Your child needs a GP and a course of antibiotics. Bacterial skin infections like impetigo may also need treatment. If you are unsure, see a doctor rather than waiting.