Fifth Disease: What Every Parent Needs to Know
If your child suddenly wakes up with bright red cheeks and a lacy rash on their arms or legs, you’re not alone—and it might just be something called Fifth Disease, a common viral rash that affects kids, especially in the spring.
Let’s walk through what it is, what causes it, what symptoms to look for, and how to care for your child at home—along with some important precautions, especially for pregnant people.
What Is Fifth Disease?
Fifth Disease, also called erythema infectiosum, is caused by a virus called Parvovirus B19. It's most common in kids ages 5 to 15 and usually spreads in schools or daycare settings. It’s called "fifth" because it was historically the fifth rash-causing illness to be identified in children (after measles, scarlet fever, rubella, and another unnamed rash illness).
The good news: Fifth Disease is usually mild. Most kids feel okay or have mild cold-like symptoms before the rash appears. But the rash itself can look dramatic—especially the classic “slapped cheek” appearance.
Why Does the Rash Happen (Especially on the Cheeks)?
The virus infects and temporarily stops the production of red blood cells in the bone marrow. While this doesn’t usually cause issues in healthy children, the immune response to the virus causes inflammation in the small blood vessels of the skin—called a “vasculitic reaction.” This inflammation, combined with circulating immune complexes, leads to the bright red cheeks and the lacy, net-like rash on the arms, legs, and trunk.
The cheeks are more affected because of the density of superficial capillaries and thinner skin in that area, which makes any inflammation more visible. And once the immune system kicks into gear, that’s when the rash shows up—often days after your child is no longer contagious.
What Are the Symptoms of Fifth Disease?
Fifth Disease happens in two stages:
Stage 1: Early “cold-like” symptoms (when the virus is contagious)
Mild fever
Runny nose
Sore throat
Headache
Fatigue
Stage 2: The rash (when the virus is no longer contagious)
Bright red cheeks—like a “slapped” appearance
Lacy, pink rash on the arms, legs, or torso
Rash may come and go, especially with changes in temperature or sun exposure
Some children may also have mild joint pain or swelling
The rash can last for several days to a few weeks and may look worse with heat, sun, or activity—but that doesn’t mean the infection is getting worse.
What to Do at Home
There’s no specific treatment for Fifth Disease—because it’s a virus, antibiotics won’t help. Here’s what you can do to support your child at home:
Fever or discomfort: Use acetaminophen (Tylenol) or ibuprofen (Motrin) as needed for fever, headache, or joint pain (based on your child’s age and weight).
Hydration: Keep fluids going—water, breastmilk, or Pedialyte depending on age.
Rest: Encourage quiet play or rest as needed—most kids feel well enough to play.
Avoid sun or overheating: Heat can make the rash look more dramatic. Keep your child cool and in the shade when possible.
Keep fingernails trimmed: In case the rash becomes itchy, short nails help avoid skin damage.
When to Seek Help
Most kids with Fifth Disease recover just fine at home. But you should reach out to your pediatrician if:
Your child has a weakened immune system (from a medical condition or medication)
Your child has a known blood disorder like sickle cell disease or thalassemia (Fifth Disease can trigger a temporary drop in red blood cells)
Your child is very tired, pale, or breathing faster than usual
The rash becomes painful, blistered, or unusually widespread
Your child has significant joint pain or swelling
Important Precautions
Here’s what parents should know about contagion and special populations:
Children are most contagious during the early cold-like phase—before the rash appears.
Once the rash shows up, your child is no longer contagious, and it’s safe to return to school or daycare as long as they feel well.
Pregnant people should take special precautions. If a pregnant person is exposed—especially in the first half of pregnancy—they should contact their OB provider. In rare cases, parvovirus B19 can affect the fetus and cause complications.
Handwashing and avoiding close contact during the early illness phase can help prevent spread—though it's often already passed by the time we recognize it.
And Just Remember…
Fifth Disease may look alarming, especially with those vivid red cheeks—but it’s usually mild, self-limited, and a normal part of childhood illnesses. Once the rash appears, it’s a sign that the immune system has done its job. In most cases, all your child needs is comfort care, hydration, and rest. And that lacy rash? It’s just their body’s way of waving goodbye to the virus.
Sending you a big hug,
Anjuli
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Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.