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?
On darker skin, spots can be harder to see. Check paler areas such as the palms, the soles, inside the lower eyelids, and the roof of the mouth.
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.
If the rash does not fade under the glass, call 995 now. Do not wait to see if the spots spread. Do not wait for your child to seem more unwell. Describe the rash to the call handler.
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
Ask your pharmacist or GP about an antihistamine suitable for your child's age. Call 995 if the face, lips or tongue swell with any breathing difficulty. Go to A&E if they swell without breathing difficulty.
Fever, often with mouth ulcers
Spots or small blisters on the palms and soles
Manage fever and mouth pain for comfort. Keep offering drinks.
Fever with spots that appear in crops
Itchy spots that turn into blisters and then crust
Manage fever for comfort with paracetamol, not ibuprofen.
Other warning signs with any rash
Even with a blanching rash, get help now if your child has any of these:
Call 995 now if your child has a fever and any of these:
- !A seizure lasting more than 5 minutes (give rectal diazepam if a doctor has prescribed it, and still call)
- !Struggling to breathe (skin pulling in under the ribs, nostrils flaring, or grunting), pauses in breathing, or lips turning blue or grey
- !Cannot be woken, or floppy and not responding to you
- !A rash of small red or purple spots that does not fade when you press a glass on it
- !Swelling of the lips, tongue, or face, with any difficulty breathing
- !Cold, clammy, or mottled skin, with drowsiness or restlessness
Go to the nearest 24-hour A&E or children's emergency now if:
- !Hives with swelling of the face, lips or tongue, even without breathing difficulty
- !Dislikes bright light, with a headache or stiff neck
- !A baby under 3 months with a temperature of 38.0°C or above
- !A first febrile seizure, even if it has stopped
- !After a seizure: confused, still drowsy after 30 minutes, or more than one seizure in a day
- !A stiff neck, or crying in pain when bending the head forward
- !Unusually drowsy or hard to wake, but can be woken
- !Dengue warning signs as the fever comes down: tummy pain, repeated vomiting, bleeding gums or nose, or very tired
- !No urine or wet nappy for 12 hours or more
- !No tears when crying, sunken eyes, or a very dry mouth
- !Cannot keep any fluids down
- !Green vomit
- !A temperature above 40°C that is not coming down, and your child seems unwell
See your GP or polyclinic the same day, or go to A&E if your child is getting worse, if:
- The rash is spreading rapidly or new spots are appearing quickly.
- Your 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 makes the most dangerous cause less likely. Check the rash again every few hours, and act on how unwell your child is, not only on the glass test. 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. Ask your pharmacist or GP about an antihistamine suitable for your child's age. Call 995 if hives come with swelling of the face, lips or tongue and any difficulty breathing. That can be anaphylaxis. Go to the nearest 24-hour A&E or children's emergency if hives come with swelling of the face, lips or tongue, even without breathing difficulty.
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.