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Group A Strep and Scarlet Fever

Scarlet fever, which is caused by the bacteria Group A streptococcus, is usually a mild illness but it is highly infectious. It is much more common in children than in adults.

It is important that children with scarlet fever are assessed by their GP so they can be started on antibiotics. This will reduce the chances of their infection becoming more severe and stops the infection spreading to others.

The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 days. It is often feels like 'sand paper' but is not itchy.

Your child may also have a:

  • Sore throat or tonsillitis
  • Fever (temperature of 38°C or above)
  • Painful, swollen glands in the neck
  • A red tongue (strawberry tongue)

16a-scarlet-fever.jpg Picture credit: Skin Deep

If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.

Occasionally, the bacteria causing scarlet fever can spread to other areas of the body causing infections in the neck (tonsillar or lymph node abscesses), chest infections (pneumonia) or sepsis.

In addition, a small number of children experience complications in the week or two after recovering from scarlet fever. This can affect their kidneys (post-streptococcal glomerulonephritis) or their joints (post streptococcal arthritis).

When should you worry?

If your child has any of the following:

  • Becomes pale, mottled and feels abnormally cold to touch
  • Is going blue around the lips
  • Too breathless to talk, eat or drink
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting
  • Has a fit, seizure
  • Becomes extremely agitated (crying inconsolably despite distraction)
  • Confused, floppy or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the Glass Test)
  • Is under 3 months of age with a temperature of 38°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

You need urgent help.

Phone 999 or go to the nearest Hospital Accident and Emergency Department

If your child has any of the following:

  • Is finding it hard to breathe
  • Unable to swallow saliva
  • Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours)
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Develops a painful, red swollen gland in their neck which is increasing in size
  • Is 3 to 6 months of age with a temperature of 39°C or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Continues to have a fever of 38°C  or more for more than 5 days
  • If your child has recently had scarlet fever but now appears to have a puffy face, eyelids, tea 'coca cola' coloured urine (pee), or a swollen, painful joint(s)
  • Is getting worse or if you are worried

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111

We recognise that during COVID, at peak times, access to a health care professional may be delayed. If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, then consider taking them to your nearest A&E

If none of the above features are present

Additional advice is also available to young families for coping with crying of well babies.

 

 

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 or contact your local community pharmacist

This guidance has been reviewed and adapted by healthcare professionals across West Yorkshire with consent from the Hampshire development groups.

What should you do?

  • If you think your child has scarlet fever, they should be assessed by their GP. They may need treatment with antibiotics.

  • To make your child more comfortable, you may want to lower their temperature using paracetamol (calpol) or ibuprofen. If you've given your child one of these medications and they're still uncomfortable 2 hours later, you could try the other medication. If this works, you can alternate paracetamol and ibuprofen (every 2 to 3 hours), giving only 1 medicine at a time. Do not give more than the maximum daily dose of either medicine.

  • However, remember that fever is a normal response that may help the body to fight infection and paracetamol or ibuprofen will not get rid of it entirely. Paracetamol and Ibuprofen bring down the temperature but do not treat the infection so whilst your child is unwell they will continue to get temperatures once the effects of the medication have worn off.

  • Avoid tepid sponging your child. It doesn't actually reduce your child's temperature and may cause your child to shiver.
  • Encourage them to drink plenty of fluids.
  • Good hand hygiene is important to stop the spread of bugs. Teach your child to wash their hands properly with soap for 20 seconds.
  • Use a tissue to catch coughs and sneezes. Keep away from others when feeling unwell.

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How long will your child's symptoms last?

  • The sore throat and fever often last for about 3 to 6 days and the rash usually improves within a week. Antibiotics reduce the length of fever or sore throat by about 1 day.
  • Children commonly experience peeling of their fingers and toes after scarlet fever.
  • Your child is no longer infectious to others (contagious) after 24 hours of starting antibiotics and can go back to school or nursery if they feel well enough.

Where should you seek help?

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

All community pharmacies across England are required to be Healthy Living Pharmacies. This means that they are able to offer advice on a range of healthy living matters which includes eating a healthy diet. They can provide information leaflets and give parents, carers and young people more information about other organisations that might also be able to help.

Pharmacists are experts in many aspects of healthcare, and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment, and many have private consultation areas. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand. Watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns, or to the Community Paediatricians, or the child and adolescent mental health services.

 

Contact your local Health Visiting Team:

Bradford Health Visitors or call - 01274 221223

Wakefield Health Visitors or call - 0300 373 0944

Craven Health Visitors or call - 01423 544265

Leeds Health Visitors or call - 0113 843 5683

Calderdale Health Visitors or call - 030 0304 5555 (local rate number)

Kirklees Health Visitors or call - 030 0304 5555 (local rate number)

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

For more information about what Health Visitors do: What does a health visitor do?

School nurses care for children and young people, aged 5 to19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and, or emotional health needs.

 

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse. Phone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Contact your local school nursing team:

Bradford School Nurses 01274 221203

Wakefield School Nurses (0 to 19 service) 0300 373 0944 (local rate number)

Leeds School Nurses 0113 843 5683

Calderdale School Nurses 030 3330 9974 (local rate number)

Kirklees School Nurses 0300 304 5555 (local rate number)

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

All children should be registered with a GP. Anyone in England can register for free with a GP surgery. You do not need proof of address or immigration status, ID or an NHS number.

How to find your local GP.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand. Watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Please note, the online version of NHS 111 is only recommended for children over the age of 5. If your child is under 5 years old, please phone 111.

NHS 111 can also direct you to your nearest urgent treatment centre (minor injuries unit or walk-in centre).

Find your local urgent treatment centre.

When to visit an urgent treatment centre.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as:

  • loss of consciousness
  • breathing difficulties
  • severe bleeding that cannot be stopped
  • major trauma such as road traffic collisions

If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand. Watch this video with them about going to A&E or riding in an ambulance