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Scarlet fever in children fact sheet

Scarlet fever in children

Scarlet fever is an infection caused by the bacteria Group A Streptococcus, also known as Streptococcus pyogenes. Scarlet fever can cause a sore throat and in some cases a skin rash. Symptoms develop when the bacteria release toxins that spread to the body through the bloodstream. The rash is caused by a toxin produced by the bacteria and released into the bloodstream.

It can spread and be transmitted to other people in close contact/proximity to a person via large droplets.
If left untreated, Scarlet fever can cause serious complications such as Acute rheumatic fever which can lead to Rheumatic heart disease. While this uncommon, it is a serious complication and the reason for commencing and completing treatment as recommended.

Signs and symptoms

The main signs and symptoms of Scarlet fever include:

  • fever
  • red, sore throat
  • rash which starts at the head and neck and spreads to the body, arms and legs. It appears within 24-48 hours and fades within 3-4 days.
  • skin feels rough, like sandpaper. It may peel (like a sunburn) after the rash is fading, and most commonly occurs on the hands, feet or in the nappy or groin areas.
  • skin looks red with red spots that turn white when pressed
  • red tongue with bumps, it may have a strawberry-like appearance
  • white spots at the back of the throat
  • swollen lymph glands at the neck.

How is Scarlet fever diagnosed?

Scarlet fever is diagnosed by a doctor, after a physical examination. The doctor may take a throat swab, which is a sample from the throat collected by your doctor, for testing.

Unless your child is very unwell, or there is a need to rule out other conditions, further tests are generally unnecessary.


Treatment is a 10-day course of penicillin antibiotics. It usually takes 48 hours to see an improvement.
Encourage your child to rest and give them paracetamol and/or Ibuprofen to help manage any pain or fever.

Give your child drinks containing sugar such as juice, milk or an electrolyte replacement solution which is available from your chemist. If your child’s urine is light yellow in colour, that’s a good sign that they’re getting enough fluid.

When your child feels well, they can resume school or day care. However, they should have their antibiotic treatment for more than 24 hours before they attend.

It’s important to wash hands and items your child uses for eating and drinking to prevent the spread of infection.

Key points

  • This illness causes a sandpaper like red rash, sore throat and fever.
  • Take the full course of antibiotics.
  • Good hygiene, including hand hygiene, is very important to stop transmission.
  • Regular analgesia will help encourage a good fluid intake

When to see your doctor?

If your child has signs and symptoms of Scarlet fever, see your GP.

If your child has been diagnosed with Scarlet fever and they are:

  • in pain, even though they are taking paracetamol or ibuprofen
  • refusing or are unable to drink
  • not passing very much urine
  • not getting any better.

Developed by the Emergency department, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS355 Reviewed: June 2021

This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.