What Is Fifth Disease? A Pediatrician’s Guide for Parents

If your child comes home from school or daycare with bright red circles on their cheeks, don’t panic. It’s probably not an allergic reaction or a severe skin infection. Those spots are likely fifth disease, a usually mild viral infection.

The telltale sign is what has long been called a “slapped cheek” rash. This illness got its name from where it fell on the historical list of six common skin rash illnesses in children.

What Is Fifth Disease?

Fifth disease is caused by parvovirus B19 (also known as Erythema infectiosum). It spreads through respiratory droplets. That makes kids, who often cough and sneeze without covering their faces, a prime target.

Outbreaks of fifth disease are common among preschool-age and elementary school-age children, especially in late winter to early spring. In August 2024, however, the Centers for Disease Control and Prevention reported a rising number of cases of fifth disease in the U.S. The biggest increase was among children from 5 to 9 years old.

The good news: Once your child has had fifth disease, they are immune and cannot get it again.

Adults can get fifth disease, too, but most infections are in children because many adults — as many as 50 percent by age 20 — are already immune.

Distinguishing Rashes of Fifth Disease

Fifth disease starts off like many other viral infections. Because of this, it can be hard to know for sure if your child has it. Before diagnosing fifth disease, your child's pediatrician will look at their facial rash, which provides the best clue.

Sometimes another rash that looks lacy appears on your child’s body a few days later. This second rash often starts on your child’s trunk and spreads to their arms, legs and even the soles of their feet. It may be itchy but usually goes away after about a week.

Even after your child is better, a rash can reappear weeks or months later. This typically happens when your child is hot, like while they are exercising or bathing.

Other Symptoms of Fifth Disease in Children

About 1 in 4 people who are infected with parvovirus B19 will have no symptoms. When symptoms do occur, they usually are mild and may include:

• Low-grade fever
• Headache
• Cough
• Sore throat
• Runny nose
• Joint pain
• Muscle aches
• Fatigue

These symptoms usually show up four to 14 days after being exposed to the virus, with the “slapped-cheek” rash showing up about four to 21 days after your child gets infected.

Your child is most contagious in the first five days before the rash appears. Once the rash appears, kids are no longer contagious.

How To Treat Fifth Disease

In most healthy children, fifth disease is harmless and resolves on its own. There is no specific treatment. Supportive care for your child includes rest, fluids and over-the-counter pain relievers or fever reducers, such as acetaminophen or ibuprofen.

Seek medical attention if your child shows any of these symptoms:

• Dehydration
• Difficulty breathing
• Chest pain
• Severe joint pain or swelling
• Rapidly worsening rash

Kids with weakened immune systems or chronic diseases are at a higher risk of severe parvovirus B19 infections.

To prevent fifth disease, good hygiene is necessary. Remind your child to cover their mouth and nose with a tissue, and not their hands, when coughing or sneezing and to throw dirty tissues away. Teach proper handwashing technique — wet, lather, scrub, rinse and dry — and the key times to wash hands, such as after using the bathroom and before eating. It is also important to make sure surfaces and objects are cleaned and sanitized regularly.

This content is not AI generated.