Roseola: Symptoms, Rash, Contagious Period and Home Care

Roseola is a common viral illness in babies and toddlers that causes a sudden high fever for a few days, followed by a pink, non-itchy rash once the fever breaks.

Roseola often catches parents off guard: a baby runs a very high fever for days, and just as it breaks, a rash spreads across their chest and back. Cleveland Clinic notes the rash is a sign the fever has resolved.

This guide covers roseola symptoms, the rash on different skin tones, the contagious period, daycare, measles and other look-alikes, and when to call your pediatrician, including febrile seizures.

What Is Roseola? The Short Answer

Roseola has several other names. The American Academy of Pediatrics (AAP) calls it roseola infantum, sixth disease or exanthem subitum, and Cleveland Clinic adds “three-day fever” and “baby measles” (it is not related to measles). Most cases are caused by human herpesvirus 6 (HHV-6), and a few are caused by human herpesvirus 7 (HHV-7), according to Cleveland Clinic.

The AAP says roseola mainly affects children about 6 months to 2 years old and that almost all children get it in their first 2 years. MedlinePlus, from the National Institutes of Health (NIH), says it is most common from 6 months to 1 year. Cleveland Clinic reports it causes up to 45% of fevers in U.S. infants and is most common in spring and fall.

Roseola Symptoms: Fever First, Rash Second

The clue that sets roseola apart is the order of events: the fever comes first and the rash appears only after the fever breaks.

The mood point surprises many parents. Cleveland Clinic notes some children stay alert and playful while others are fussy, especially when the fever is high. Watch how your child acts, not only the thermometer.

Roseola Rash: What Does It Look Like?

We describe the rash in words, because rashes look different on every skin tone. Use these features as a checklist:

• Color: Pinkish red on lighter skin. The AAP says it may look faint red or purple on darker skin, and Cleveland Clinic notes it can be harder to notice on darker skin.
• Shape and texture: Small, slightly raised spots (MedlinePlus), or flat and raised areas mixed, usually separate rather than merged (Cleveland Clinic).
• Blanching: Cleveland Clinic says the spots blanch, meaning they fade or turn white when you press on them.
• Where it starts: On the trunk: chest, back and belly. It then spreads outward to the neck and arms, and sometimes the legs and face (AAP, Cleveland Clinic, MedlinePlus).
• How it feels: Usually not itchy and not painful (AAP, Cleveland Clinic, MedlinePlus).
• How it ends: It fades without treatment and, per Cleveland Clinic, does not peel.

Searching for “roseola rash pictures”? The timeline is more telling than any photo: days of high fever, the fever ends, then a non-itchy spotty rash on the body. A rash that turns into blisters or sores, or appears on the lips or inside the mouth, is a reason to contact your doctor (AAP). The rash needs no treatment (Cleveland Clinic). For other common baby skin spots, see our guides to baby acne, stork bites and diaper rash vs yeast infection.

Is Roseola Contagious? How It Spreads and for How Long

Yes, roseola is contagious. The AAP says the virus spreads through coughing and sneezing, and Cleveland Clinic adds that it spreads through saliva and respiratory droplets. It can spread before symptoms appear (Cleveland Clinic).

Cleveland Clinic advises keeping your child away from children with weakened immune systems while they are sick, and says frequent hand washing is one of the best ways to reduce viral infections. There is no vaccine for roseola.

How Long Does Roseola Last? A Day-by-Day Timeline

Sources give slightly different ranges:

Sleep often goes sideways during the fever days and can take a few nights to settle after. Our guide to baby sleep when sick covers adjusting naps and bedtime.

Roseola Fever and Febrile Seizures

Cleveland Clinic calls febrile seizures the most common complication of roseola and reports that they affect 10% to 15% of children aged 6 to 18 months with roseola, usually on the first day of fever.

The AAP says febrile seizures happen between 6 months and 5 years, most often at 12 to 18 months, usually in the first hours of a fever. A child may stiffen, twitch and roll their eyes, briefly stop responding, or change breathing or skin color. Most last less than 1 to 2 minutes, do not cause brain damage or lasting problems, and are outgrown by school age.

Fever medicines can lower a fever but do not prevent febrile seizures (AAP), so a seizure is not a sign you waited too long. What to do during one, and when to call 911, is in the pediatrician section below.

How to Care for a Child With Roseola at Home

There is no specific medicine for roseola. It is a virus, so antibiotics do not help (Cleveland Clinic), and the AAP says the infection should improve on its own. Care focuses on comfort and fluids.

• Offer plenty of fluids: The AAP says to encourage fluids to prevent dehydration, even if your child isn’t hungry. For babies, that means breast milk or formula.
• Dress them lightly: Cleveland Clinic suggests lightweight clothing and avoiding heavy blankets. See baby room temperature for sleep.
• Cool sponge bath, if it helps: MedlinePlus mentions cool sponge baths along with fever medicine.
• Ask your pediatrician about fever medicine: Cleveland Clinic says a pediatrician may recommend children’s acetaminophen or ibuprofen. Ask your pediatrician for dosing based on your child’s weight. The AAP says not to give ibuprofen to babies younger than 6 months unless your child’s doctor tells you to, and Cleveland Clinic says never to give aspirin to anyone under 17 because of the risk of Reye’s syndrome.

Safe sleep does not change during an illness. A baby under 12 months should still sleep alone, on their back, on a firm, flat, bare surface, with no pillows, blankets, wedges or positioners, even with a stuffy nose or fever. If your child has a medical condition or takes immune-suppressing medicine, Cleveland Clinic says they may need special care, so call your pediatrician early.

Roseola vs Measles: How to Tell the Difference

Roseola’s nickname “baby measles” causes confusion. Only a clinician can tell for sure, and Cleveland Clinic says to call your pediatrician right away if you suspect measles.

The simplest rule: in roseola the child usually feels better by the time the rash appears, while in measles the rash arrives while the child is still sick and feverish.

Roseola vs Hand, Foot and Mouth Disease and Other Rashes

• Hand, foot and mouth disease: A different virus, known for mouth sores and spots on the hands and feet. The AAP says to contact your doctor if a rash becomes blisters or sores or affects the lips or inside of the mouth.
• Teething-related drool rash: Sits around the mouth, chin and neck where drool collects. Our teething rash guide covers it, and when babies start teething explains the timeline.
• Other look-alikes: Cleveland Clinic says doctors rule out a drug allergy, ear infection, measles, rubella and scarlet fever when they diagnose roseola.

Roseola often overlaps with teething age; teething and sleep explains what teething can cause.

How Doctors Diagnose Roseola, Plus HHV-6 and HHV-7 Explained

Roseola is usually diagnosed from symptoms, the timeline and an exam. The AAP says lab tests are not very useful, and Cleveland Clinic says blood tests are rarely needed. It often becomes clear only when the rash appears.

Cleveland Clinic says most people develop immunity to HHV-6 or HHV-7 after one infection; getting roseola twice is possible but rare, and more likely with a weakened immune system. Can adults get roseola? Cleveland Clinic says it is rare for older children or adults, since most children have it before school.

Serious complications are rare. MedlinePlus lists aseptic meningitis and encephalitis, and Cleveland Clinic adds pneumonia, more likely in children with weakened immune systems.

Related Betteroo Guides

• Teething rash (drool rash)
• Baby sleep when sick
• Baby acne
• Baby room temperature for sleep
• When do babies start teething?
• Diaper rash vs yeast infection

When to Call Your Pediatrician

Call your pediatrician if:

• A baby younger than 3 months with a temperature of 100.4 F (38 C) or higher. The AAP says to call right away.
• A temperature that repeatedly goes above 104 F (40 C), or a fever that lasts more than 24 hours in a child under 2 (AAP).
• Your child looks very ill, is unusually drowsy or very fussy, or is very sleepy and hard to wake (AAP).
• Not drinking well, few wet diapers, or signs of dehydration such as a dry mouth and no tears (AAP, Cleveland Clinic).
• A rash that turns into blisters or sores, affects the lips or inside the mouth (AAP), or is itchy or painful (Cleveland Clinic).
• Your child still seems unwell after the fever ends (Cleveland Clinic, AAP), or has a fever along with a weakened immune system or heart condition (AAP, Cleveland Clinic).
• A febrile seizure in a child who has had them before (Cleveland Clinic).

During a febrile seizure, the AAP advises:

• Lay your child on the floor or a bed, away from hard or sharp objects.
• Turn their head to the side so saliva or vomit can drain.
• Do not put anything in their mouth. They will not swallow their tongue.
• Time the seizure, then call your child’s doctor.

Call 911 if a seizure has not stopped after 5 minutes (AAP). Cleveland Clinic also lists these reasons to call 911 or seek emergency care: a first-time febrile seizure, any febrile seizure lasting five minutes or longer, difficulty breathing, a weak or high-pitched cry, neck stiffness or pain, frequent vomiting, or lethargy.

After any seizure, call your child’s doctor right away. The AAP says the doctor will want to examine your child to find the cause of the fever. This article is general education, not medical advice.

Frequently Asked Questions