What Is Fifth Disease (Parvovirus B19) In Children?

Learn symptoms of fifth disease in children, how to treat the symptoms of fifth disease, and when you should see a doctor about your child's illness.

Fifth disease is a mild viral illness that causes a rash. Today, we’ll cover what parents need to know about fifth disease, including symptoms, tips for relief, and when you should see a doctor about this illness.

What is fifth disease?

Fifth disease is the common name for erythema infectiosum, a mild illness caused by the parvovirus B19. This illness causes viral rashes, among other symptoms.

  • It is more common in children than adults, and most common in preschoolers and school-age children.
  • This illness is also called “slapped cheek disease,” because it causes children to develop a flushed-looking rash on their cheeks.
  • Fifth disease got its common name because it was fifth on a historical list of common illnesses that cause children to develop skin rashes.

Learn more about fifth disease from Akron Children's Hospital:

Symptoms of fifth disease

As mentioned above, the most notable symptom of fifth disease is “slapped cheek” rash.

But the viral rash isn’t usually the first symptom to appear.

About 80% of the time, fifth disease causes these symptoms first:

  • Low fever
  • Headache
  • Runny nose
  • Congestion
  • Sore throat
  • Achy muscles or joints (much more common in adults, though)
  • Nausea
  • Fatigue

These symptoms will usually show up 4 to 14 days after a child is exposed to the parvovirus, and tend to last for a few days to a week.

After these symptoms resolve, the viral rash appears. (Or, about 20% of the time, children don’t have any symptoms beforehand, but suddenly develop the illness’s signature rash.)

The “slapped cheek” rash is the first stage of the rash. It causes the cheeks to appear flushed as if they were slapped. It will appear bright red on lighter skin. On darker skin, it will appear subtly red, reddish-purple, or slightly lighter than the person’s skin color.)

A second stage of the rash may appear a few days later. In this second stage, the rash looks lacey and flat, appears purplish-red or reddish-brown, and can sometimes be itchy. It may spread to the trunk, arms, and legs during this stage.

This stage of the rash usually lasts 2-4 days. But the rash could last, or come and go, for several weeks.

It may also go away, then reappear when your little one gets hot or cold, when their skin is injured, or when their skin is exposed to sunlight.

How do doctors diagnose a child with fifth disease?

Often, doctors diagnose fifth disease just by looking at the rash, since the rash is very distinct. But without the rash, your doctor will need more information. They may ask about your child’s symptoms, and check your child’s health history. Sometimes, the doctor will run a blood test, to check if your child has antibodies to the parvovirus B19.

Is fifth disease contagious?

Like other viral illnesses, fifth disease is contagious. It is spread via direct contact with droplets from the nose and mouth, such as when someone coughs or sneezes. In children, fifth disease most often spreads in the winter and early spring.

Someone is most contagious with fifth disease before they develop the rash (and when they may have initial symptoms like the low fever, runny nose and/or headache). If your child appears to develop early symptoms of fifth disease, or any viral illness, limit their exposure to others, so they don’t spread the illness.

Once someone develops the viral rash, they are no longer contagious with fifth disease.

And most of the time, once someone recovers from fifth disease, they’ll develop an immunity and won’t contract fifth disease again.

Can fifth disease cause more serious complications?

In most cases, fifth disease is mild in children. But rarely, fifth disease can cause more serious complications.

Fifth disease can affect the way the body produces red blood cells. And if a child has sickle cell disease, another blood disorder, or a weak immune system (such as from leukemia or certain cancers), this can put them at risk for anemia (a lack of healthy red blood cells). As a result, fifth disease may require them to be admitted to the hospital.

How to treat fifth disease?

Fifth disease will eventually go away on its own as your child’s body fights against the illness. Antibiotics won’t work to treat it, as they don’t treat viruses.

But there are some ways to make fifth disease bearable for your little one.

  • Give your child acetaminophen (Tylenol) to alleviate fever and pain
    • For babies and young children, only give if baby is over 12 weeks old and it’s approved by your pediatrician
  • Give your child ibuprofen (Motrin) to alleviate symptoms
    • For babies, only give if baby is over 6 weeks old and it’s approved by your pediatrician
  • Make sure your little one gets extra rest and drinks plenty of fluids.
  • If your child’s rash is itchy, ask your pediatrician if they recommend a topical treatment, as a way to soothe it.
    • Also, cover the rash areas so your child does not scratch.
  • If your child has a rash and does not have a fever, bathe your child in a cool or lukewarm bath to soothe them.
    • A cool bath is soothing for children with viral rashes. But if your child has a fever, cool water may cause shivering, which may make the fever worse.

NEVER give a child aspirin as a way to treat fifth disease, or treat any illness. Aspirin may put your child at risk for Reye’s syndrome.

When to see a doctor about fifth disease?

Remember that fifth disease is usually mild. There are some reasons that may merit or need a doctor visit, though:

  • You’re concerned about your child’s symptoms and want to know what’s causing them
  • You want to ask your doctor if you can give your little one medicine or topical treatment
  • Your child seems lethargic or in pain

Call your doctor right away if:

  • Your child’s symptoms get worse instead of better
  • It’s been several days since the rash developed, and the rash has not improved
  • Your child has anemia
  • Your child has a blood disorder or a weak immune system, and you suspect fifth disease
  • Your child has the rash and fever at the same time (as usually the rashes follow the fever)
  • Your child’s joints look swollen
  • Your child seems very pale or dehydrated

Fifth disease vs. other causes of rashes

There are many different types of viral illnesses that cause rashes. And rashes can also be caused by other conditions that don’t involve viruses, like food allergies and eczema.

How to tell if your child has fifth disease, another viral rash, or a completely different type of rash? Read our viral rash guide to find out.

Reducing the risk of catching or spreading fifth disease

There are several ways to reduce the risk of fifth disease --- and many of these good habits help reduce the spread of other viral illnesses as well.

  • Teach your child good hand hygiene: frequently washing hands with soap and warm water for at least 20 seconds.
  • Minimize contact with people who are sneezing, coughing, and/or frequently blowing their nose.
    • If your child is the one coughing or sneezing, and they are old enough to learn, teach them to cover their mouth and nose with their elbow or a tissue.
    • If your child uses a tissue, make sure they throw it in the trash, and then have them wash their hands.
  • Sanitize objects and surfaces that multiple people touch regularly, especially if someone is sick.

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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.  If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.