Those Irritating Childhood Rashes

Grandma says it looks like measles to her!" Most likely, some variation of this statement has been heard more than once in every pediatrician's office. And grandmothers usually know best, especially when it comes to raising children. But Grandma raised her children in a different era, and thanks to the development and widespread acceptance of vaccines, measles are very rare in our country now. So what are those red dots on the little one's skin?

A rash is any eruption of the skin. Almost all rashes are red, however, they can come in many different shapes and sizes. Some are flat reddened areas of skin; others are a bit swollen. Some are acute and last only a few hours; others go on and on for weeks or more. Some occur along with fever and other symptoms. Rashes themselves may feel warm to the touch, but that does not necessarily indicate general fever.

In this article are outlined some of the characteristics of rashes and the symptoms and conditions that may accompany them. This is not an attempt to make you a "rash expert," but to help caregivers understand what may be happening so you can help the parent explain the symptoms to the child's parent or doctor. As a childcare provider, it may help to accurately describe the rash and other visible symptoms, as well as take precautions against the spread of disease if warranted by the type of rash. Is the rash flat or raised? Are the spots big or little? Are there blisters? Is the child sickly, feverish, or scratching the rash? These are important things to note when reporting the rash to parents and health professionals.

Location

First, where is the rash located? Is it localized or all over the body? This is important. A few rashes occur in very localized areas of the body, such as the bridge of the nose, cheekbones, palms and soles, or behind the ears. Also, in what we call contact dermatitis, the rash occurs only where the offending agent touched the skin. For example, some jewelry has nickel in it, and that jewelry can cause a rash where it touches the skin of a person who is allergic to nickel.

Approximately 85 percent of people are allergic to poison ivy, so the sap of poison ivy very quickly irritates the skin with an allergic reaction. This very itchy, rough rash usually appears within a few days after contact with the weed, however, some people get a rash within an hour after contact. The rash is limited to areas of the skin that actually touched the sap of the plant (and sap is present year round, even when the leaves are gone). The rash will not spread if it is scratched. A more serious rash can result from being in the smoke of burning poison ivy or poison oak, because the smoke contains minute droplets of the sap of the burning plant. This rash can cover the entire body and can put people in the hospital.

Hives

Another common rash is called hives. With hives (also called urticaria) large blotches suddenly appear, often looking like huge mosquito bites. This rash is somewhat raised and is usually very itchy. It is often widespread, occurring in several areas of the body at the same time. Hives usually last from a few minutes to a few hours but can last much longer. This usually indicates an allergic reaction to a food or medicine. Because it is an allergic reaction, hives generally respond well to antihistamines.

Hives can occur in the mouth and on the lips if the person has eaten a food or taken a medicine that produces a very severe allergic reaction. Fortunately, this type of reaction is not common; but when it does occur, it should be treated as an emergency because breathing difficulty may result. Oral hives respond within minutes to a shot of epinephrine (if prescribed by the child's doctor).

Other Rashes

Some rashes, such as chickenpox, have tiny blisters in them. Other rashes, such as scarlet fever, feel a bit like sandpaper and appear all over the body. Certain rashes, such as eczema, are scaly, usually itchy, last a long time, often months, and may be widespread. Even though this kind of rash may be widespread, it tends to be more evident in certain areas, like behind the ears, behind the knees, or in the bend of the elbow.

Diaper Rash

All parents and caregivers are familiar with diaper rash. It has been said that the only children who never have diaper rash are those who never wear diapers. It is caused by the continued moisture of a wet diaper next to the skin. Certain compounds in the urine, notably ammonia, can be irritating. Aggravating factors include plastic pants over the diapers and simple failure to frequently change the diapers. There are many creams and other preparations on the market that are beneficial for diaper rash. The best one is the one that works best for you, but avoid cortisone creams.

A complication of diaper rash is yeast infection, also called candidiasis or monilia. Yeast infection looks like a severe diaper rash, but does not respond to usual measures. The diagnosis of yeast infection should be made by a physician. Yeast infection also may appear in the mouth. This type of infection is called thrush and looks somewhat like milk curds.

Contagious Rashes

A rare but very important type of rash looks like tiny (pinhead size) hemorrhages beneath the skin. These rashes differ from the ones we have been describing, and they are cause for immediate serious concern. If this type of rash is accompanied by a sore throat or fever, assume that the child has an infection and may be contagious. When the child is contagious depends on the condition. For example, with the disease known as "fifth disease," the contagiousness is gone by the time the rash appears. In other infections, such as chicken pox, children are contagious for two-three days before the rash shows up and the contagious period lasts about a week.

Most rashes are not contagious themselves, but the diseases that cause them can be passed on by respiratory droplets or hand contact. Only a few rashes are contagious, including shingles, impetigo, and ringworm. If children have any of these, the rash (or skin sores) should be covered until a doctor says they are not contagious.

Sometimes, rashes can be alarming, while at other times they may go practically unnoticed. In all cases, attention to detail and referral to the child's health care provider are important. Childcare providers and health consultants can play an important role in monitoring and describing rashes and helping parents communicate with physicians.

By Don Palmer, MD, FAAP
Member of the AAP Committee of Early Childhood, Adoption and Dependent Care

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; www.aap.org

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs: Second Edition. The text can be found on line; nrc.uchsc.edu. The book can be ordered by calling the American Academy of Pediatrics, 888-227-1770.

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