Roseola (Sixth Disease)

Roseola is a common viral infection that mainly affects young children. It’s often seen in children between 6 months and 2 years old. While it can concern parents, roseola is usually mild and manageable at home.

At Banner Health, we’re here to help. Learn about roseola, its symptoms, causes and how to care for your child with this illness.

What is roseola?

Roseola is a contagious viral illness (virus) commonly affecting children under 2 years old. It is also known as exanthem subitum (sudden rash) and sixth disease (named after the sixth common childhood rash scientists named).

Your child can catch roseola anytime, but it is more common in spring and fall. It is known for a sudden high fever followed by a rash as the fever fades. Most cases of roseola are mild and do not lead to complications. 

What causes roseola?

Two types of herpes virus cause roseola. The most common is human herpes virus 6 (HHV-6), and sometimes human herpes virus 7 (HHV-7). Despite being in the same family as herpes simplex viruses (HSV), roseola does not cause cold sores or genital herpes. 

Children usually catch the virus from close contact with a family member or a caregiver who passes the virus but has no symptoms. Older siblings typically don’t catch roseola because they already have had the illness.

What are the symptoms of roseola?

The symptoms of roseola can be divided into two stages: the fever stage and the rash stage. 

Fever stage

• High fever: The first sign of roseola is a sudden, high fever. The fever can reach 103°F (39.5°C) or more. It usually lasts three to seven days.
• Fussy: Children may be irritable or fussy during this time.
• Swollen glands: Some children may have slightly swollen glands in the neck.
• Mild runny nose or cough: A few children might also experience a runny nose, sore throat or cough.

Some children also develop pink eye and may experience loss of appetite, vomiting and diarrhea. 

Rash stage

• Red rash: After the fever breaks, a pinkish-red rash usually occurs. The rash starts on the chest, back or stomach (tummy) and then spreads to the neck and arms. It might also reach the legs and face. 
• Non-itchy: The rash is usually flat or slightly raised and does not cause itching.
• Short duration: The rash lasts from a few hours to a few days before fading. 

How does roseola spread?

Roseola spreads through contact with an infected person’s saliva or respiratory droplets. It can be passed on through coughing, sneezing or sharing cups and utensils. 

Symptoms usually start five to 15 days after exposure to the virus. Children are most contagious during the fever stage, even before the rash appears.   

How is roseola different from measles?

Roseola and measles both cause rashes in children, but measles differs in important ways:

• How it spreads: Measles is caused by a highly contagious virus that spreads through the air over relatively long distances (even many feet away, sometimes across entire buildings). 
• Rash and fever: The measles rash is red and blotchy, starting on the face and spreading downward while the fever is still present. 
• Severe complications: Unlike roseola, measles more commonly can lead to serious complications, especially in unvaccinated children. These include pneumonia, encephalitis (brain swelling) and death. However, the good news is the MMR vaccine prevents measles.

How is roseola diagnosed?

Your child’s health care provider can diagnose roseola by looking at your child’s symptoms, especially the pattern of high fever followed by a rash. Blood tests are rarely needed unless there is a concern about another infection.

What is the treatment for roseola?

Most cases of roseola are mild and can be managed at home. There is no antiviral therapy available for roseola.  Here are some tips to help your child feel better:

• Use fever-reducing medicines: Children’s acetaminophen (Tylenol) can help lower fever and make your child more comfortable. If your child is older than six months of age, they can also take ibuprofen (Advil). Always follow the dosage instructions on the label or ask your child’s provider. Do not give your child aspirin, as it may cause more problems.
• Keep your child hydrated: Encourage your child to drink plenty of fluids, such as water, clear soups or an oral rehydration solution like Pedialyte. If your child is still breastfeeding or drinking formula, they should continue to do so. You can supplement with Pedialyte if they are not tolerating the breastmilk or formula.
• Rest: Make sure your child gets plenty of rest while recovering.
• Cool baths: A lukewarm bath can help soothe your child and reduce fever. Avoid cold baths, which can cause shivering and may raise the fever.

Talk to your child's provider if you have questions about managing roseola. 

What are the complications of roseola?

Most children do not have health complications from roseola. While rare, some children may experience a convulsion (febrile seizure) if their fever becomes high or spikes quickly. Although scary in the moment, these seizures usually do not cause lasting harm to your child.

Have your child evaluated by a medical provider after a febrile seizure to make sure there isn’t something else causing it that would require additional testing and treatment.  Call 911 if the seizure doesn’t resolve on its own. Do not try to treat their seizure at home. You should also seek emergency care if your child has difficulty breathing or loss of consciousness (passes out). 

Call a health care provider if your child:

• Has a fever of 102°F (39°C) for 24 hours or longer.
• Has a rash that is itchy or painful.
• Has signs of dehydration.
• Has a weakened immune system or heart condition. These children may respond differently to a fever. Your provider can give you guidance on what you should do.

Prevention tips

Preventing roseola can be challenging because the virus is common and spreads quickly. However, you can reduce the risk by practicing good hygiene:

• Wash your hands often, especially after changing diapers, wiping a runny nose and before eating.
• Don’t share cups, utensils or towels with an infected child.
• If your child has roseola, keep them at home until they are no longer contagious. This usually means staying home until the fever has stayed normal for at least 24 hours.
• Keep your child’s immunizations up to date. Vaccinations like those for MMR and varicella (chickenpox) help prevent certain viral infections that can lead to conditions like roseola. 

For more preventive measures, talk to your child’s health care provider. You can also learn more about common rashes in childhood.