Scarlet fever is a very contagious infectious disease, especially affecting babies and toddlers. The triggering bacteria, so-called streptococci, are transmitted via the smallest drops of saliva and can lead to symptoms such as fever, sore throat, difficulty swallowing, a specific skin rash as well as headache and body aches. If the disease is diagnosed, rapid antibiotic therapy must be initiated to avoid possible sequelae or late damage such as rheumatic fever or acute nephritis.


Scarlet fever in the baby is caused by an infection with bacteria of the genus Streptococcus. These bacteria can be found in the saliva of every human and are transmitted via the so-called droplet infection. By sneezing, sniffing, coughing or speaking the bacteria get into the ambient air and can penetrate into the mucous membranes of the babies.
In many cases, infection is via a parent or sibling. The babies and children who are in close contact with a sufferer are thus particularly at risk. Especially in community facilities, such as toddler groups or day care centers, a scarlet fever disease can spread very quickly.
The bacteria settle in the mucous membranes of the mouth and throat and release there certain toxins, known as toxins, which eventually lead to the onset of scarlet fever. The body's own immune system of the baby arms against the toxin, which has already triggered the scarlet fever disease. If you re-infect with the same toxin your body will be immune and the typical symptoms of scarlet fever will not break out. However, there are several streptococcal strains, each producing different toxins. Another streptococcal strain with a toxin that is still unknown to the body can therefore cause a re-infection.


The first symptoms of scarlet fever occur in most cases after an incubation period of about 5 days. The sick babies stand out due to fatigue, drinking weakness and elevated temperatures. In the first few days, babies are sometimes struck by malaise, abdominal pain and vomiting.
The patients have severe sore throat and can not swallow properly. This is because both the tonsils and the palate are heavily swollen and a reddish inflamed mouth and throat area becomes visible. On the pharyngeal tonsils develop in the course of small whitish specks, which may be missing in the initial phase of the disease. In addition, there is an inflammation of the neck and jaw lymph nodes, which is accompanied by a swelling and painful increase in size.
In addition, changes in the skin occur. Starting from the inguinal region and the underarm area of ​​babies spreads a fine-blotched rash over the entire body. It is striking that the skin around the mouth is not affected and appears pale. This phenomenon, typical of scarlet fever, is also referred to as perioral paleness. After two to three days, the diseased baby's tongue turns raspberry red and the taste buds on the tongue surface swell and form prominent sublimities.
Many sufferers also suffer from a purulent cold or inflammation of the middle ear, as the pathogens can also accumulate in the back nasal passages and thus lead to ascending infections.

Itching in scarlet fever

In addition to scarlet fever, there are several other infectious diseases that can affect babies and children. In measles or rubella infections, skin rashes also develop that spread across different parts of the body and have a very specific appearance pattern. These rashes are most often felt to be particularly uncomfortable, as they are accompanied by a strong, tormenting, unpleasant itching. The babies suffer greatly from the itching, are very whiny and difficult to calm down and begin to scratch or scratch the affected areas of the skin for relief.

Learn more about the rash in children

The typical skin rash as part of a scarlet fever disease usually does not itch. This significantly facilitates the healing process, as the babies are calmer and happier on the whole.

Rash in scarlet fever

The typical rash that occurs in a scarlet fever disease usually begins on the second day of illness. As a rule, it begins in the skin areas of the groin and axillary region and spreads from there, ascending to the neck, over the entire body. Typically, the skin area is recessed around the baby's mouth. The skin appears pale and even here. This phenomenon is also called perioral paleness.
The rash on the rest of the body appears pale red at the beginning and pin-point-sized, closely spaced patches emerge, which in most cases are well distinguishable and do not merge. After one to two days, they turn scarlet and in some areas flow into a diffuse rash. The spots are slightly raised and have a rough character. In contrast to other rashes associated with infectious diseases in babies or children, such as measles or rubella, babies do not suffer from a nagging itch in a rash as a result of scarlet fever. After about 4-6 days, the rash slowly fades again. During the healing phase most of the time the baby's palms and soles become flaky. This scaling affects only the superficial layers of the skin.

Fever in scarlet fever

As scarlet fever is an infectious disease, it causes a high fever in most cases. The first symptoms that stand out in the sick babies are usually an expression of fever. The babies appear very sleepy, are beaten off, very whiny and show a marked lack of drinking. The elevated body temperature is a defense mechanism of the body's immune system to combat the invading pathogens. At elevated temperatures, the multiplication of pathogens is restricted and the further spread prevented. Children with diseased skin may experience high temperatures of up to 39 ° C, which is often accompanied by fever and chills.

Discolored tongue in scarlet fever

As part of a scarlet fever in the baby, show some symptoms that are quite characteristic of the presence of the disease. The tongue looks pale at the beginning of the disease and is covered by a whitish coating.
After two to three days, the coating dissolves, the tongue swells and appears in a shiny raspberry red. In addition, there is a swelling of the taste buds, which are distributed on the tongue. They look like tiny specks that emerge from the tongue surface.


If the diseased babies already have the characteristic skin rash at the time of presentation to the doctor, the diagnosis can usually be made at first glance. If the babies have only general signs of infection, such as fever or fatigue, the diagnosis is much more difficult.
It is important to carry out a detailed physical examination. The doctor should absolutely inspect the mouth and throat and the ears. Particular attention should be paid to enlarged cervical lymph nodes, ( see also: swelling of the lymph nodes on the neck) as well as reddened tonsils with a whitish coating or a reddened tongue with swollen taste buds.
Blood tests usually show elevated levels of white blood cells or erythrocyte sedimentation rate. In addition, there are specific antibodies in the blood, which increase in a scarlet fever infection.
In addition, the doctor can perform the so-called rumple-leed test. This will inflate a blood pressure cuff on the baby's arm or leg for approximately 5 minutes. In a scarlet fever, then, small violet hemorrhages in the skin may arise.

Quick test

To diagnose a scarlet fever, an antigen rapid test can be used. Here, a swab of the pharyngeal mucosa of the baby is removed with a cotton swab. After a few minutes, the doctor can read in the test whether the throat of the patient is colonized with streptococci.
It is important to remember that this test does not detect or indicate all scarlet fever diseases. If the test is positive, there is an infection with streptococci and should be treated as soon as possible with an antibiotic. If the test is negative, the test should send another throat swab to the lab. Here the possibly existing bacteria can be bred and reliably proven.


The right treatment for scarlet fever in a baby is the initiation of antibiotic therapy. The first-choice antibiotic is penicillin and is also given intravenously in babies, usually in the form of juice or while in hospital.
Above all, the purpose of the antibiotic is to prevent the sick babies from becoming infected as soon as possible. After more than 24 hours of antibiotic therapy there is usually no risk of infection. Read more under: How Contagious is Scarlet Fever?
In addition to antibiotic therapy bed rest and physical protection should be respected. If the babies are suffering from a high fever, it is also important to ensure adequate drinking and hydration. Also antipyretic agents such as acetaminophen can also be used. It is also particularly important to comply with the prescribed intake time of the antibiotic. This should be prescribed for a total of 10 days. Only then can the risk for possible long-term consequences such as a disease of the heart or kidneys be reduced.

Is there a vaccine?

There is no active vaccine against the scarlet fever disease. After a persistent infection, you can re-infect with another streptococcal strain that forms another toxin, and the disease may recur. After a 24-hour antibiotic treatment, the ill baby is no longer infectious. However, if the disease is cured without antibiotic therapy, there is a high risk of infection until the end of the entire symptoms, ie up to three weeks.


As with other infectious diseases, scarlet fever can lead to severe courses and complications.
There may be a toxic course with diarrhea, vomiting, cramps and dizziness. In addition, there is a risk of blood poisoning, which can lead to meningitis or blood clots in the baby's brain. Also, neurological deficits and seizures may occur. Another consequence is rheumatic fever. The immune system produces antibodies against the streptococci, which in turn can react with the body 's own tissue and thus lead to joint - heart and kidney damage. The risk of acute nephritis, called glomerulonephristis, is also increased. Overall, the risk of long-term consequences and secondary diseases can be significantly reduced if the disease is detected early and treated with antibiotics.

  • Blood poisoning in children
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A scarlet fever in the baby can take up to 3 weeks. If an antibiotic therapy is initiated early, the symptoms improve significantly after one to two days. After about 4 to 6 days, the rash returns and a little later the dandruff begins on the hands and feet. Overall, it may take up to 14 days until the babies are no longer choppy and limp. In rare cases, the disease may be associated with a serious course of complications and the occurrence of long-term consequences.

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