"She has Scarlet Fever"

It started with a low-grade temperature, sneezes, and general fatigue on Thursday. She did mention a sore throat (which made me think Strep throat right away). I kept my daughter home from preschool. Each time I measured her axillary (under armpit) temperature it was normal, but her tactile temperature felt much warmer. She even looked flushed. In the afternoon, it actually was 98.9 degrees F (at or above 99 is considered a fever). I didn't quite trust the digital thermometer because she still felt warm and she kept saying she was cold. By the way, KidsHealth offers a terrific summary of fever in children. My daughter was actually very whiny and looked ill. I offered her chewable acetaminophen (generic Tylenol) tablets to help her rest better (note, I expected her to refuse). She took all 3 tablets and actually liked it. After a while, she took a nap. I kept asking her if her throat still hurt, and she kept denying it. So much for my strep theory. She also slept through the night.

The next morning, she asked for more acetaminophen, but she clearly did not need it. She claimed that her throat hurt a little. After she drank some water, she said it was better. Maybe because I kept offering to take her to the pediatrician if her throat still hurt. In any case, she looked 100% better and was jumping, singing, and dancing. I wondered if I should let her go to school, but it was suggested that she go because she's turned around. "Does your throat hurt?" "Just a little." Later, "no." She was fine the rest of the day; just one or two sneezes. There was a case of strep reported in the 3's class. Since she didn't ever have a fever, I kept it on the back burner. What my daughter has is probably just viral; the common cold.

Saturday morning, my husband noticed a rash on her cheeks. He relayed that to me, but I must not have heard him. Her throat hurt in the morning, but then it didn't. We went to a ballet performance and then a late lunch/early dinner. No sneezing. She ate like a champ. In the evening, though, when I gave her a bath, I noticed a rash on her back, her trunk, and her pelvic area. There were a few blotches of red, but the rest were small and skin colored. They felt like sandpaper. They reminded me of goose pimples. We thought she might have fifth disease, which is caused by parvovirus. She did develop the rash 2 days after the "fever" and she was flushed (slap cheek). Since she didn't have a fever, I decided to wait until Monday to bring her to the pediatrician to take a look. In 5th disease, once the rash breaks out, the child is no longer contagious. Here is a good collection of skin rash photos.

On Sunday, she developed a few little red lesions around her mouth, but otherwise fine. We ran errands and all was well. The red lesions on her body were fading in color, but the sandpaper rash was still there.

On Monday, the lesions around her mouth were still there. She woke up a little later than usual, but was chipper. I brought her to school and then was able to schedule an appointment with the pediatrician. When I brought her in, he took one look at the rash and said, "She has scarlet fever." He then looked at her throat and took a sample for a throat culture. She was started on cefdinir (Omnicef) twice a day for 5 days. Sure enough, the culture was positive for strep in less than 24 hours. I should have trusted my initial instinct.

Cefdinir liquid is white and tastes bitter (not like the acetaminophen chewable tablets), but I explained to my daughter the rationale for taking this. I let her eat a piece of gummy candy and then drink from the medicinal spoon. We repeated this a few times. I even diluted the remaining volume (1 mL with water), but she quickly asked if she had to drink it all. Next time I will not dilute it with so much water. This morning, she refused to take it, but I gave her a freeze pop to numb her tongue and to cleanse her palette after each swallow. It worked like a charm.

We're home for a couple of days because scarlet fever is highly contagious. She will be allowed to return to school after being fever-free for 24 hours and after taking a full day of her antibiotic. The nurse also told me to change her toothbrush after 48 hours of starting her antibiotic. We're expecting some peeling later on in the week, but she' recover. Scarlet fever is not as life-threatening as it seems if treated in a timely manner with appropriate therapy. I'm glad I brought her in.