UNC Health Care
rosy cheeks on toddler

Does Your Child Have Fifth Disease?

Picking up your child from school or day care, you notice he looks pretty flushed. It looks like he ran a marathon, maybe even fell on his face. What happened? He feels warm, so you head to the doctor.

A quick exam later, it turns out that the flushed face is a rash from fifth disease, and your child has actually been sick for a while. The characteristic “slapped cheek” rash—named because it appears as rosy cheeks, as if your child were slapped—is one of the first visible signs of fifth disease but also an indication that your child is no longer contagious.

Try to remain calm. Fifth disease might look and sound bad, but like other viruses, it just needs to run its course.

What Is Fifth Disease?

Fifth disease, also known as erythema infectiosum, is a common viral infection in children caused by parvovirus B19.

“Fifth disease is spread through respiratory secretions, such as saliva or nasal mucus, when people are coughing or sneezing,” says Katie Garland, a nurse practitioner with UNC Family Medicine & Pediatrics at Holly Springs. “When kids are in school coughing and sneezing around one another in close proximity, that’s a good time for them to catch it.”

Between four and 12 days after exposure to the virus, people with fifth disease may start to exhibit flu-like symptoms, which can include a fever, runny or stuffy nose, headache, and joint and body aches. During this time, people are infectious.

About two weeks after those symptoms, the slapped-cheek facial rash appears, a sign that you or your child is no longer contagious. A second, lacy rash may also appear about one to four days later on the arms, legs or torso. This second rash affects only some people, but it can be itchy and it may fade and come back a few times over several weeks.

Although fifth disease typically affects kids, that doesn’t mean that adults can’t contract the virus. “When an adult gets exposed, the joint pain is often more severe. They can also experience the fever, some GI upsets, headache, sore throat and general malaise,” Garland says. Adults are also less likely to get the slapped-cheek rash.

For pregnant women and people with a diminished immune system, such as those with cancer or HIV, contracting the disease poses more risks, according to the Centers for Disease Control and Prevention. Although complications are rare, fifth disease can cause miscarriage, and some babies have developed anemia. People with weakened immune systems may also be contagious longer.

How to Prevent Infection When You Can’t Tell Who Is Sick

The tricky part about fifth disease: When people are infectious, they might be marching around not knowing that they are sick.

“They have exposed everybody already because they just don’t know, which makes it tricky to keep people well,” Garland says.

Proper hygiene precautions, such as washing hands with soap and water, using hand sanitizer and covering your mouth when you cough or sneeze, can help you steer clear of any virus, including fifth disease.

“I also recommend making sure that your kids are getting adequate sleep so that they are not getting run-down. Eating a healthy diet to keep their immune system where it needs to be and practicing good hand hygiene are important as well,” Garland says. “Avoid close contact with other people who are sick, and if they are the ones who are sick, keep them home.”

Treatment of Fifth Disease

“When kids come in with symptoms of a fever, runny nose or the feeling of fatigue, we’re going to tell you to treat their symptoms the same as with any virus,” Garland says. “You’re going to want to keep the fever under control with either Tylenol or Motrin, make sure they stay well hydrated, and rest.”

If the rash is causing discomfort, antihistamines or an oatmeal bath can bring relief to an itching child.

Like children, adults with fifth disease should treat their symptoms to recover faster.

“Use nonsteroidal anti-inflammatories such as ibuprofen or Aleve to help with the joint pain, get fluids and rest,” Garland says.

For children in school or day care, a doctor’s note saying it is appropriate for them to come to school may make an appointment with a provider necessary.

“But once he or she is no longer contagious, if the kid feels up to it, there is no reason why they can’t go to school,” Garland says.


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