15785 Roseola Infantumsixth Disease

Overview

Roseola infantum, often called sixth disease, is a common, mild viral infection that mostly affects babies and young children. It causes a few days of high fever, followed by a spotty pink rash that appears just as the fever goes away. The illness usually clears up on its own without treatment.

Yes, roseola is very common. Almost all children catch it before age 5, although many cases are mild or symptom-free.

Roseola most often affects children between 6 months and 2 years old. Older children and adults can catch it too, but it is far less common after early childhood.

Symptoms

Common symptoms

• Sudden high fever, often over 39°C, lasting 3 to 5 days
• Mild runny nose, cough, or sore throat during the fever
• A pink, spotty rash on the chest and tummy that may spread to the neck, arms, and legs after the fever breaks
• The rash is usually not itchy or painful and fades within 2 to 3 days
• Slightly swollen glands in the neck or behind the ears

Symptoms in children

• High fever for a few days, sometimes with a brief seizure (febrile convulsion) that looks scary but is usually harmless
• Irritability, clinginess, or lower energy while the fever is present
• Decreased appetite
• A rash that appears after the fever has gone down, often while the child is starting to feel better

Symptoms in older adults

• In older children and adults, roseola may feel like a mild cold with tiredness, headache, and sometimes a faint rash.
• Fever, if present, is usually lower and shorter-lived than in babies.
• Most older children and adults recover quickly without complications.

Causes

Main causes

• Roseola is caused by a virus, most often human herpesvirus 6 (HHV-6), and sometimes human herpesvirus 7.
• The virus spreads through saliva, such as when an infected person coughs, sneezes, or shares cups and cutlery.
• After entering through the nose or mouth, the virus multiplies in the body before symptoms appear.

Risk factors

• Being between 6 months and 2 years old, when maternal antibodies have faded
• Attending childcare or having older siblings who may carry the virus
• Not having had roseola before — once you have had it, you are usually immune for life

When to see a doctor

See a doctor urgently if:

• Your baby is under 3 months old and has any fever
• The fever lasts longer than 5 days
• Your child shows signs of dehydration, such as a dry mouth, no tears, or far fewer wet nappies
• Your child has a seizure, even if it is brief
• The rash is associated with high fever, looks unusual, or does not fade when pressed

Book a routine appointment if:

• You are worried about your child's fever, rash, or general condition
• You would like advice on keeping your child comfortable during the fever
• You are unsure whether your child can return to nursery or school after symptoms improve

Diagnosis

Doctors usually diagnose roseola by asking about symptoms and recognising the typical pattern of a high fever followed by a rash. No special tests are needed for most children.

Tests that may be done

• Usually no tests are needed.
• If the diagnosis is unclear, a blood test or swab may be used to rule out other infections such as measles, scarlet fever, or a urinary tract infection. This is uncommon.

What to expect at your appointment

Your doctor will ask about your child's fever and rash, check their temperature, look at the rash, and listen to their chest. They will likely reassure you that roseola is a mild illness and give guidance on how to manage fever and fluids at home.

Treatment

Roseola is a viral infection, so antibiotics do not help. The body clears the virus on its own. Treatment focuses on keeping your child comfortable, managing fever safely, and making sure they drink enough fluids.

Self-care at home

• Encourage rest and extra fluids — breastmilk, formula, water, or diluted fruit juice.
• Dress your child in light clothing and keep the room at a comfortable temperature. Do not overheat or over-cool them.
• Wipe your child gently with lukewarm water on a cloth if they are uncomfortable with fever — never use cold water or ice.
• Let the rash run its course. It does not need creams or lotions.
• Keep your child home from nursery or school until the fever has gone and they feel well again.

Medical treatments

Your doctor or pharmacist may suggest a suitable over-the-counter fever-relief medicine for children. Always follow the dosage instructions for your child's age and weight, and never give aspirin to a child under 16. If a febrile seizure happens, protect your child from injury, lie them on their side, and call emergency services.

Living with this condition

During the fever, your child may be clingy, tired, and less interested in food. This is normal. Once the rash appears, their mood often improves quickly. Keep activities calm and quiet until the fever has completely gone and your child feels like their usual self.

Lifestyle tips

• Encourage quiet play, reading, and cuddles rather than running around while the fever is present.
• Wash hands regularly, especially after touching used tissues, changing nappies, or wiping noses.
• Avoid sharing cups, bottles, cutlery, or toys that go in the mouth while your child is infectious.

Diet and exercise

Offer small, frequent drinks and light meals such as soup, toast, or fruit. Do not force food — a reduced appetite for a few days is normal. Let your child's appetite guide them as they recover, and gradually return to normal activities once they feel better.

Mental health and emotional wellbeing

Looking after a feverish child is tiring and can make any parent anxious. Remember that roseola is mild and short-lived. It is okay to feel worried — talk to your partner, family, or a friend, and reach out to your doctor if you need reassurance.

Prevention

There is no sure way to prevent roseola because the virus is so common and spreads easily through everyday contact. Good hand hygiene and not sharing cups or cutlery can reduce, but not eliminate, the chance of spreading the virus.

Vaccines

There is no vaccine for roseola.

Screening programmes

No screening tests are available for roseola.

Complications

If left untreated

• Febrile seizures — a brief seizure triggered by fever — are the most common complication in young children. They look frightening but are usually harmless and do not cause lasting damage.
• Dehydration can happen if a child refuses to drink during the fever.
• Very rarely, roseola can lead to inflammation of the brain (encephalitis), but this is extremely uncommon.

Long-term outlook

Almost every child recovers completely from roseola within a week without treatment. After the infection, most people are immune for life. Serious complications are very rare, and with simple home care, the outlook is excellent.

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