Tips for Treating
Toddler Skin Rash

Overview

There are a wide variety of causes for toddler skin rash that may include, but are not  limited to, allergies, an infection, a virus, a parasite or a drug reaction. Typically, skin rash in children is diagnosed based on the appearance of the rash, rash location, blisters and any accompanying symptoms such as fever, lack of appetite and lethargy. Clues can be provided by exposure to other sick people, antibiotic use, tick bites, other bug bites, immunization reactions, time of year, and possible environmental causes. If rash is accompanied by fever and lethargy, be sure to call your pediatrician immediately, particularly if the rash cannot be blanched (place thumbs together on rash, pull apart, if skin turns white, probably not an emergency, if skin stays red, call Doctor - see video at end of article). This is only a guideline, as this site is for information only and does not replace the advice of a medical professional.

The good news is that many rashes are caused by viruses, don’t hurt your toddler. In fact, most of them fade without needing treatment.

There are some rashes however, with serious or life-threatening causes. Many rashes look the alike which makes it hard to know the precise diagnosis. If you don’t know what you are dealing with, call your doctor for an appointment immediately.

In all cases of toddler skin rash, the physician will do a visual examination. Even Doctors can have a tough time diagnosing a rash, since the same underlying condition can result in rashes that are different from person to person.

If necessary, they may do skin tests to determine what they are dealing with in terms of the rash affecting your child. There may also be a round of blood tests (a complete blood count), UV light analysis and other specialized tests for the disease your doctor may suspect your toddler has.

Don't try and diagnose a toddler skin rash yourself.  Instead use these descriptions to have a productive and informed conversation with your Doctor. 

This site is not meant to be a replacement for the advice of your physician.

When to Call the Doctor

Toddler skin rash is difficult for even Doctors to diagnose.  Be sure to note any symptoms that occurred before the rash appeared such as fever, changes in behavior (lethargy, tiredness), appetite change etc.

This site is not a substitute for your pediatrician.  Use the information provided at your own discretion.  It is always best practice to call your pediatrician, particularly when your child has a fever accompanied by rash.

As noted in the video above, a quick way to tell if a rash is an emergency is to take your two thumbs, put them together, press the skin and pull apart.  If the rash fades and turns white when pulled apart by pulling the thumbs apart, the rash is much less likely to be an emergency.  If you pull the skin area with your two thumbs in opposite directions and it doesn't turn white, then you should contact your pediatrician regarding the toddler skin rash immediately. 

Descriptions and Causes

When calling the doctor use the following language to describe the rash. Descriptions include possible causes.

• Scaly/Crusty: often starts as a blister and is common to disease such as ringworm, impetigo and chicken pox.
  
• Blotches: flat and usually does not have one color. In the case of allergic reaction part of rash may be flesh colored while rest is red
• Welt: raised, part skin color and red. Can be large or small, often an allergic reaction that results in a hive.
  
• Pustule: Blister that is filled with pus. Common in cases of chicken pox, poison ivy and acne.
• Lacy: Flat and mottled red skin irritation. Caused by Fifth's disease.
• Flat: You cannot feel the skin irritation to the touch. Often caused by eczema or sun rash.
• Raised Irritation: you feel any skin bumps or dots. Caused by heat rash, molluscum and roseola.

Types of Skin Rash in Children

The most common causes of toddler skin rash includes:

Chicken Pox Skin Rash

Chicken pox is highly contagious and caused by varicella-zoster. While not harmful to most children, it may last 2 weeks and make your toddler uncomfortable. May be serious for those with weak immune systems.

The first signs of chicken pox are usually fever and sore throat and being extremely tired. Within 24 hours, the chicken pox rash appears, starting at the head and torso then spreading to arms and legs. Raised pimples appear on the skin.  A blister is present in the middle of rash. When it breaks, it scabs over. The rash lasts about 7 to 10 days.

There is no treatment per se for chickenpox, other than to give supportive symptom care. Do not give your toddler aspirin, as you run the risk of Reye’s syndrome.

Coxsackie viruses, Herpangina and other enteroviruses (hand, foot and mouth disease)

These families of viruses are very common. The two most often seen diseases in toddlers are hand, foot and mouth disease and Herpangina.  It is more common in the summer.

For hand foot and mouth disease, toddlers have moderate to high fever for 1-2 days and then the rash appears (101 to even 105 degrees Fahrenheit).  There is only a concern if the fever does not go away for a couple of days (call your Doctor whenever a child has a high fever).

It is called hand, foot and mouth disease because this is where the toddler skin rash appears 

It can cause blisters in the mouth and on the tongue (with difficulty swallowing), palms and soles of the hands and the feet. Blisters look like pin pricks. It may occur on the buttocks or the genital area.

Herpangina appears with a fever, headache, sore throat, and painful blisters/ulcers in the back of the mouth.

No specific treatment is needed other than Tylenol or Motrin for fever. Be aware of the risk of dehydration, so encourage the child to drink. Live cultured yogurt and Benedryl can help with the sores in the mouth.

It is difficult to tell the difference between this toddler skin rash and strep, so be sure to see a Doctor.

Toddler Eczema

Toddler Eczema is characterized by  atopic dermatitis (skin reaction) including Itchy and dry skin, which usually runs in a family. A medical history of asthma, food, seasonal allergies and allergic sinus problems are related to the condition. There are several types of eczema including conditions caused by allergy (food, medication) or direct contact with a trigger such as plants or clothing.  The cause may not be identified.

Symptoms of toddler eczema develop on the cheeks in infants, but in older children is seen on the truck in a 1 year old.  In children older than a year, it appears on the wrists, knees, finger creases and elbows. In the beginning skin rash can start and stop.  It is characterized by red skin patches,  Patches feel rough, but can become itchy, scaly and crusted. 

Use fragrance-free soaps for body and laundry. Moisturizers for skin hydration. Topical steroids may be prescribed, applied after bath to retain skin moisture. Antihistamines for itching. With staph bacteria, antibiotics. Non-steroidal anti-inflammatory creams may be used if corticosteroids don’t work.  Over the counter hydro-cortisone ointment can be used (1/2% or 1%) under the direction of a Doctor when a flareup occurs.

If allergy is the cause, elimination of the allergen is important.  

Warning: The herpes virus can result in a skin infection in children with eczema.  Keep adults with herpes virus cold sores away from children with this condition.

Fifth Disease
(Parvovirus B19 erythema infectiosum)

Fifth disease in toddlers is referred to as “slapped cheeks” disease and erythema infectiosum and is caused by human parvovirus B19.  It usually occurs in Spring, and occurs when children are 18 months to 2 years and older.  The rash is benign (harmless) in most children.

Toddler fifth disease may come on mimicking a cold, with the rash appearing after the viral illness is gone and the toddler is not contagious any more. You may see bright red cheeks that look like the child was slapped. When that fades, the red, lacy looking rash spreads to the body, mostly the arms. This toddler skin rash may result in the patient having sore joints, knees and elbows.

There is no specific treatment for this disease, other than supportive symptomatic care.  The condition can last as long as 6 weeks.  It can become more pronounced after the child is engaged in exercise.  Once the rash breaks out and the child no longer has a fever, the rash is not contagious.  Alert your child's teacher in to avoid exposure if the teacher is pregnant.

If the child's temperature is 101 to 103, it if probably not Fifths Disease, but is Strep.

Toddler Hives (Urticaria)

Hives are common in toddlers. They are raised irritated areas of skin that are covered with a rash and skin bumps. They and are referred to as wheals. Wheal size varies from 1/2 inch to a few inches wide. Large wheals can have a pale center.

Toddlers often get hives due to some type of allergy, insect bite reactions or as a reaction to medication.  In the winter, colder air can also be a cause of toddler hives.  Symptoms such as skin itch can come before the appearance of hives. The hives might move from one part of the body to the other, disappearing from one, only to reappear somewhere else.  Hives usually go away on their own in 3 to 4 days, and last no longer than 10 days.

f a toddler has a mild case of hives, no treatment is necessary other than something to help keep a child from itching such as an oral antihistamine.  A cool bath or a natural remedy such as Itch Be Gone could also help with itch.

Chronic or severe cases of toddler hives require emergency treatment. This includes trouble breathing, trouble speaking (hives can affect the mouth), fever (associated with serum sickness) and joint pain.

Impetigo

Impetigo is caused by strep or staph bacteria and is usually found around mouth and nose, but may appear anywhere. It can be a secondary infection with damaged skin. Extremely contagious.

Toddler impetigo begins with small superficial blisters that break open leaving red, open patches of skin which then form a honey colored crust.

Toddler skin rash treatment for impetigo involves topical or oral antibiotics prescribed by your Doctor.  A Doctor may suggest softening the skin crust by soaking them in warm water (or use a washcloth for 10 to 15 minutes, 4x per day). Follow this softening by washing the area with a mild soap (don't rub or pull the scabs as this can cause pain).  After scabs are removed apply an antibiotic ointment multiple times each day to kill the bacteria.

Kawasaki Disease

Toddler Kawasaki disease is also referred to as mucocutaneous lymph node syndrome and has no identifiable cause. Scientists think it is caused by a bacteria or virus, but do not know for sure.. It may affect a toddler’s heart if not treated promptly. Seek emergency medical help as soon as possible.  It is very rare in children and affects children age 1 to 2 years old.  The condition is not contagious and can be treated if caught early.  The disease effects 4000 to 5000 cases each year.  Heart problems can be avoided if treated within the 10 days.

Kawasaki disease symptoms includes high fever for five days straight, red eyes with no discharge, swollen lymph in neck, red cracked lips, strawberry tongue, red eyes and throat, which may be cracked, redness/swelling of toes/fingers with peeling of fingertips, rash may be varied and flat or raised or with blisters.   The hands and feet can turn red.

There is no test to diagnose this disease. The doctor uses evaluative criteria as mentioned about in Symptoms of Toddler Skin Rash. Toddlers may have an elevated platelet count and signs of inflammation. Some patients develop aneurysms or their coronary arteries. Toddlers with Kawasaki are put into hospital and put on IV gamma globulin and high doses of aspirin. Following treatment, a child's temperature will return to normal, although some children may have a recurrent fever.

Lyme Disease

Lyme disease in toddlers is caused by deer tick bites.

Toddler Lyme disease starts with flu-like symptoms, followed by a characteristic circular rash several days to weeks later. Starts with red nodule which gets smaller, but a large red ring spreads out from it. The rash is called erythema migrans and can be small or up to 12 inches wide. Fever, sore throat, stomach pains, neck pain and stiffness, paralysis of the facial nerve, cough.

If you suspect a tick bite, see your doctor immediately. If not treated, may affect the heart rhythm, cause chronic arthritis, brain swelling etc.  

Lyme disease in children can be treated with antibiotics (tetracycline or penicillin) and is most effective is started within 1 month of becoming infected.

Measles

Measles in children are caused by a paramyxovirus.

Signs of measles generally arrive 10-12 days after being exposed. Symptoms often starts with stuffy nose and cough, red eyes with no discharge and fever ranging 102 F-103F. Fever elevates to 104F-105F and a brown rash (can also appear as pink flat spots) appears on face, hairline and behind ears, then spreads down to thighs and feet. Rash disappears after a week.

There is no medication for measles. Give supportive symptom care.

Meningococcemia

Meningococcemia is also known as meningococcal sepsis. It is life threatening. Neisseria meningitidis bacteria invades the blood. Warning: Haemophilus influenzae, streptococcus pneumonia and staph cause similar symptoms. If you aren’t sure what the rash is, call for medical help right away.

Fever and a petechial rash are symptoms. See Fever and Petechiae above. The rash can appear as large bruises on the body. May be congestion, headache, nausea, vomiting and sore muscles, delirium and seizures, which may progress to being unresponsive and comatose. See warning above in Causes of Toddler Skin Rash.

Treatment must be administered at a hospital and involves IV antibiotics. Treatment  may require a spinal tap and blood tests. Often fatal, even with antibiotic therapy.

Fever and Petechiae

Petechiae are red/purple flat spots on the skin that do not fade when pressed. The dots are bleeding from the capillaries and form a small blood blister. See warning above in Causes of Toddler Skin Rash. Toddlers with Petechiae may look healthy, but get very sick, very quickly.

Petechiae may resolve in about 7 days without treatment. A Doctor “must” assess your child to see if further tests etc. are needed.

Prickly Heat

Prickly heat in children occurs during the hot weather when the natural cooling function of the body, sweating, cannot keep up with the high outside heat or humidity condition.

Prickly heat symptoms starts on the neck and shoulders and consists of small pimples.  Some of the pimples might blister.

There is no treatment needed for Prickly Heat other than keeping the toddler out of the heat and humidity.

Ringworm

Ringworm is caused by a skin fungus called dermatophytes or tinea (corporis,  faceii). May be anywhere on your toddler’s body, but usually on the face and head. Can be itchy.

The condition is caused by a skin fungus called dermatophytes or tinea faceii. It may occur anywhere on your toddler’s body, but usually on the face and head. The fungal skin rash can be itchy.

Use topical anti-fungals for small lesions. For larger ones and ringworm in the nails or hair, oral anti fungal agents are required.  A natural topical is also available from Naturasil.

Rocky Mountain Spotted Fever

Rocky mountain spotted fever is caused by wood tick bites and may be fatal if not treated. See your doctor right away if you suspect a tick bite.

There are specific telltale symptoms, as they are common to many other sicknesses: sudden onset of high fever chills, moderate headache, nausea and vomiting often with stomach pain and fatigue. Some toddlers get a rash, others do not. Usually starts at wrists and ankles and spreads to trunk. Rash, flat and red, blanches when pressure applied. Later it becomes raised. May be fatal if not treated. See your doctor.

Treatment must be started before blood tests confirm this disease. It may not turn up positive for 10 days after the illness started. Toddlers are put in hospital and given antibiotics.

Roseola (Roseola Infantum or Sixth Disease)

Roseola is also called exanthema subitum or sixth disease and is very common. It is caused by human herpes virus 6 or 7, although 7 is not seen that much.  It is seen in children age 6 months 2 years of age.

Onset is a mild respiratory infection followed by a high fever that spikes within 2 – 7 days.  The rash follows the fever breaking.  Rash is small, flat and pink or raised lesions on the body and then spreads to the arms and legs.  Rash typically last about two days.  In 10% of children the high fever can cause seizure or convulsions.  Call your Doctor immediately when fever is accompanied by lethargy (tiredness).

No therapy available to treat this, although Tylenol may be used with care to lower the fever.  Sponging with lukewarm water can also help the child to feel better.  DO NOT give your child aspirin. and provide fluids to avoid dehydration.

Rubella (German Measles)

Rubella in children is also knows as Three Day Measles or German measles. It is caused by a Rubivirus.

Rubella has an Incubation period of 14-21 days. A toddler displays pink/light red rash on the face and body. Other symptoms are: low-grade temperature (100 F), mild joint pain, headache, red eyes without discharge and swollen lymph nodes, particularly behind ears, but also on neck.

There is no specific treatment for rubella, other than supportive care.

Scabies

Scabies is caused by a parasite that lays eggs under your toddler’s skin, causing red, itchy lesions. Toddlers contract this from contact with another person with scabies. Everyone at home needs to be treated. This is a serious skin disease. Seek medical help.

Scabies is characterized by itching at night, and areas on the skin that look like something burrowed underneath the surface.

Toddler scabies is caused by a parasite that lays eggs under your toddler’s skin, causing red, itchy lesions. Toddlers contract this from contact with another person with scabies. Everyone at home needs to be treated. This is a serious skin disease. Seek medical help.  Over the counter medications can be used which contain the insecticide benzyl benzoate.  A natural topical approach is also available from Naturasil for parents that would prefer to avoid insecticides.

Treatment involves a topical agent left on the skin overnight (see our article on How to Treat Scabies, which includes natural remedies as well).

Scarlet Fever

Scarlet fever also called Scarlatina, is strep throat with a rash. The bacteria is Streptococcus pyogenes and is very contagious. It may appear in vaginal and anal region. If left untreated, strep may cause rheumatic fever, damage heart valves or cause long-term heart problems.

With scarlet fever the skin will look sunburned and feel rough like sand paper.  The rash should heal on its own in 2 to 5 days.

Scarlet fever in children starts acutely with sore throat, moderate fever, headache, upset stomach, and swollen lymph nodes in neck. The rash appears a day after the child starts to feel sick. Rash appears that looks like a sunburn on skin that has goose bumps (feels like sand paper). Flushed cheeks. Moist part s of the body are commonly affected such as the armpits and groin. Anal or vaginal involvement may include redness and no discharge, itching and painful defecation or urination.

Typical treatment uses antibiotics of your doctor’s choice.

Toxic Shock Syndrome

Toddler toxic shock syndrome is life threatening and early on may be confused with measles, Rocky Mountain Spotted Fever and other diseases. Caused by a toxin made by streptococcus or staph aureus. Can be fatal, even with maximum treatment offered. Go to the emergency department immediately if you suspect this.

The source of infection must be found. Treatment includes the appropriate antibiotics and supportive care for circulation and major organs. Usually toddlers are admitted to intensive care for observation and therapy.

Brochures

References

Visual Guide to Children's Rashes and Skin Conditions

Slide Show: Common childhood skin problems

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