Scarlet Fever in Children: Symptoms and Treatment
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 5 November 2026
Scarlet fever gives children a fever, sore throat and rough red rash.
You don't have to figure this out alone
Dr. Pedro Yelamo Vera is an independent, bilingual GP licensed in Spain. Book a 15-minute video consultation in English or Spanish for €50, with a private electronic prescription issued under Spanish law when clinically appropriate.
Scarlet fever is an infection caused by group A strep bacteria. It gives a fever, a sore throat and a red rash that feels rough, like sandpaper. It is most common in children aged 5 to 15. A doctor treats it with a course of antibiotic, and it stops spreading about 24 hours after the first dose.
- Scarlet fever is caused by the same bacteria as strep throat.
- Fever and a sore throat come first. The rash follows 12 to 48 hours later.
- The tongue can turn red and bumpy, called a strawberry tongue.
- With an antibiotic it stops spreading after about 24 hours. Children go back to school once the fever has gone and 24 hours of treatment have passed.
- Call 112 or go to urgencias if your child struggles to breathe, cannot swallow, is very drowsy or has purple spots.
Dr. Pedro Yelamo Vera is a GP licensed in Spain (Colegiado No. 484814280).
For a medical emergency, call 112 or go to the nearest local emergency department. Do not wait for a video consultation or an online reply.
What are the symptoms of scarlet fever?
It starts suddenly, 2 to 5 days after your child catches it. The first signs are often:
- A fever, often high, for 3 to 5 days.
- A sore throat, with red or swollen tonsils.
- Swollen, sore glands in the neck.
- Sometimes a headache, tummy ache, vomiting or poor appetite.
The rash comes 12 to 48 hours later. It is made of tiny red spots that feel like sandpaper. It starts on the neck and chest and spreads down the body. It is strongest in the armpits, groin and elbow creases. The cheeks go red, but the skin around the mouth stays pale. On brown or black skin the colour is harder to see, but you can still feel the rough bumps.
The tongue may have a white coat at first. Then it turns red, swollen and bumpy: a strawberry tongue. The rash lasts 3 to 7 days. After that the skin may peel, mostly on the face, hands and feet. This is normal.
Who gets scarlet fever and how does it spread?
It is most common in school-age children and rare under the age of three. Adults can get it too, often from a child at home.
It spreads through droplets from coughs, sneezes and talking. It also spreads from hands and shared cups or toys. Some people carry the bacteria in their throat without being ill and can pass it on. It is most common in winter and spring. Having it once does not stop you getting it again.
How long is scarlet fever contagious?
With an antibiotic, your child stops being contagious about 24 hours after the first dose. Without treatment, they can spread it for two to three weeks.
When can my child go back to school or nursery?
The rules are much the same in each country, but who sets them differs:
- Spain: there is no single national rule. Each school or nursery (guardería) sets its own, so ask yours. The Spanish paediatric association (AEP) advises waiting until the fever has gone and 24 hours of antibiotic have passed.
- UK (NHS): stay off school, nursery or work until 24 hours after the first antibiotic dose.
- US: schools usually ask for the same 24 hours on antibiotics and no fever.
Our guide to how long you are contagious, illness by illness compares the most common bugs.
How is scarlet fever diagnosed?
A doctor can often tell from the symptoms and by looking at the throat, tongue and skin. To confirm strep, they may do a quick throat swab test or send a swab to the lab. On a video visit the doctor can see the rash, tongue and throat on camera. If a swab is needed, he tells you where to get one.
How is scarlet fever treated?
The treatment is an antibiotic. The doctor chooses which one, based on your child's age, weight and any allergies. It is usually a course of several days. Always say if your child is allergic to penicillin. Your prescription and the leaflet say how to take it. Finish the whole course, even if your child feels better after two days. This helps stop it coming back and lowers the risk of problems.
At home, you can help your child feel better:
- Give drinks often, cool ones are best, and soft food.
- For fever and pain, use the medicine your doctor or pharmacist suggests. Do not give aspirin to anyone under 16.
- If the rash itches, a gentle moisturising cream may help.
Antibiotics need a prescription in Spain. See why antibiotics need a prescription in Spain.
Fever, sore throat and a rough rash on your child?
You can book a video visit with a GP licensed in Spain, in English or Spanish. He looks at the throat and skin on camera, checks for warning signs and explains what to do next.
Is it scarlet fever or another rash?
- A viral rash: many viruses cause a fever and spots, but without the sandpaper feel or the strawberry tongue. Antibiotics do not help.
- Measles: starts with a runny nose, cough and red eyes. The spots appear first behind the ears and on the face.
- Kawasaki disease: a fever for five days or more, with red eyes, red cracked lips and swollen hands and feet. Your child needs to be seen in person that day.
- Impetigo: can be caused by the same bacteria, but it forms honey-coloured crusts. See our impetigo guide.
What problems can scarlet fever cause?
Problems are rare today, most of all with treatment. The best known are ear infections, sinus infections and an abscess next to a tonsil. Very rarely, weeks later, rheumatic fever can affect the joints and heart, or the kidneys can become inflamed. See a doctor if, days or weeks later, your child has dark urine, a puffy face, or red and painful joints.
When should you see a doctor or go to urgencias?
See a doctor if you think your child has scarlet fever, so it can be checked and treated. See a doctor again if:
- The fever is still there 48 hours after starting the antibiotic.
- Your child is drinking less, passing less urine or is more tired than usual.
- They have bad ear pain, or one side of the neck is very swollen.
- They have scarlet fever and chickenpox at the same time.
Call 112 or go to urgencias if your child struggles to breathe, drools because they cannot swallow, or cannot open their mouth fully. Also call if they are very drowsy or floppy, or have purple spots that do not fade when you press a glass on them. The same goes for a patch of red, hot, very painful skin that spreads fast. A baby under three months with a fever always needs to be seen in person.
Talking it through with a doctor by video
Dr. Yelamo is a GP licensed in Spain. He sees adults, children and pregnant patients by video, every day from 07:30 to 20:30 (Spain time). In the visit he will:
- Look at the throat, tongue and rash on camera and ask how it started.
- Check the fever, fluids and warning signs.
- Explain the treatment that fits and when your child can go back to school.
He does not promise any test or prescription before the visit. Where clinically appropriate, following a genuine evaluation. Treatment and prescriptions are issued solely at the doctor's discretion based on evidence-based clinical guidelines.
A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
See how the Urgent Care video visit works. It lasts 15 minutes and costs €50.
This guide is general information. It does not replace a consultation with your doctor or paediatrician.
Frequently asked questions
What does a scarlet fever rash look like?
Tiny red spots that feel like sandpaper. It starts on the neck and chest, then spreads. It is strongest in skin folds. The skin around the mouth stays pale.
How long is scarlet fever contagious?
Until about 24 hours after the first antibiotic dose. Without treatment it can spread for two to three weeks.
When can my child go back to school in Spain?
Once the fever has gone and at least 24 hours have passed since the antibiotic started. Each school or nursery sets its own rule, so ask yours.
Does scarlet fever need antibiotics?
Yes, when a doctor confirms strep. The doctor chooses the antibiotic and how to take it. Finish the course, even if your child feels better sooner.
Can adults get scarlet fever?
Yes, but it is much less common. Adults often catch it from a child at home. It is treated the same way, with an antibiotic if the doctor advises it.
When is scarlet fever an emergency?
Call 112 if your child struggles to breathe, drools because they cannot swallow, is very drowsy, stops passing urine or has purple spots that do not fade when pressed.
Related guides
Sources
This content is written and reviewed by a licensed physician with reference to the following sources.
