What is Roseola or Sixth Disease In Children?

Roseola (or sixth disease) is a common illness caused by a virus. It usually affects babies and toddlers between 6 months and 2 years of age, and it causes a viral rash to develop on someone’s body. Today, we’ll cover what parents need to know about roseola (sixth disease), including symptoms, tips for relief, and when you should take your child to the doctor.

What is roseola (sixth disease)?

Roseola (sometimes called sixth disease, exanthem subitum, or roseola infantum) is a common and usually mild viral illness. Most often, it’s caused by human herpesvirus 6, and less often, it’s caused by human herpesvirus 7 or another virus. This illness causes a sudden high fever and a viral rash, along with other symptoms that we’ll cover below.

  • Roseola is most common in babies and toddlers ages 6 months to 2 years of age.
    • But older children can also catch the virus and develop roseola.
    • Babies under 6 months of age are usually protected from roseola thanks to their mother’s immune system.
  • Roseola is also called sixth disease for two reasons.
    • It was sixth on a historical list of viral, rash-causing illnesses that affect young children.
    • And today, we know it’s most commonly caused by herpesvirus 6.

Learn more about roseola from pediatrician Dr. Dina Kulik:

Symptoms of roseola

When a child contracts the virus that causes roseola, the first symptom they usually experience is a very sudden, high fever.

  • This fever is usually over 102° Fahrenheit, and can sometimes reach up to 105° Fahrenheit.
  • It usually appears 5-15 days after exposure to the virus, and will last for about 3-5 days.

Other symptoms of roseola include cold-like or flu-like symptoms.

These may include:

  • Congestion
  • Runny nose
  • Coughing
  • Sore throat
  • Swollen glands of the neck

These symptoms usually occur along with the fever.

Then, after the fever goes away (or sometimes, during the fever), the signature viral rash of roseola appears. It is dotted and usually raised, but could also be flat. Usually, it isn’t itchy.

On children with lighter skin, this rash is rose-colored (which is where the illness got the name “roseola” from). On children with darker skin, it may be darker red, purple, or the color of the child’s skin, so it may be harder to spot.

The rash starts out on the stomach, and then spreads to other parts of the body, such as the torso, neck, and back.

The rash can last between a few hours and one to two days.

Is roseola contagious?

Roseola is a contagious illness. It is spread via droplets in the air from whenever a child with the virus coughs, sneezes, or talks. The droplets can also land on surfaces, and spread the virus whenever someone touches that surface and then touches their nose or mouth. Or, when someone hugs or otherwise makes skin-to-skin contact with someone who has roseola, the virus can spread this way as well.

A child who has roseola is contagious when they have the fever. Once they develop the rash, they are no longer contagious.

Can roseola cause more serious complications?

In most children, roseola is relatively mild. However, about 10-15% of young children who contract roseola experience febrile seizures, or seizures brought on by the high and quickly rising fever.

The febrile seizures are usually not harmful or dangerous, and most only last for a maximum of five minutes. But they can certainly be frightening, and they can sometimes cause a loss of consciousness.

Another sign of a febrile seizure is jerking or twitching of the arms, legs, or face (which usually lasts for 2-3 minutes).

If you think your child has experienced a seizure, you should talk to your pediatrician right away, or seek emergency care immediately. This way, you can make sure that the seizure isn’t caused by something more serious.

How do doctors diagnose roseola?

Usually, if roseola is suspected, a doctor will ask about your child’s symptoms and health history. They will also conduct a physical. The sudden high fever and rash will often be enough information to diagnose your child with roseola.

How to treat roseola?

Roseola will eventually go away on its own as your child’s body fights against the illness. You won’t be able to treat it with antibiotics, as antibiotics can only treat bacterial illnesses, not viral illnesses.

But there are some ways to relieve your child’s fever, rash, and other symptoms of roseola.

  • Give your little one acetaminophen (Tylenol) to relieve fever and discomfort
    • Only give acetaminophen if baby is over 12 weeks old and it’s approved by your pediatrician
  • Give your little one ibuprofen (Motrin) to relieve fever and discomfort
    • Only give ibuprofen if baby is over 6 weeks old and it’s approved by your pediatrician
  • Make sure your child is drinking plenty of fluids
  • Make sure your child is getting enough rest
  • If your child has a fever, dress them in lightweight and loose-fitting clothing
  • If your child has a rash and does not have a fever, consider bathing your child in a cool or lukewarm bath.
    • A cool bath is soothing for children with viral rashes like the one roseola causes.
    • 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 roseola, or treat any illness. Aspirin may put your child at risk for Reye’s syndrome.

When to see a doctor about roseola?

You should call your doctor about your child’s roseola if:

  • You aren’t sure what’s causing your child’s rash or fever, and you’d like a diagnosis
  • Your child (any age) has a fever of 104 degrees Fahrenheit or higher
  • Your 3-24 month old has a fever of over 100.4 degrees Fahrenheit for over 24 hours
  • Your child (older than 2 years) has a fever of over 100.4 degrees Fahrenheit for 3 or more days
  • You’ve given acetaminophen, and your little one’s fever hasn’t gone down
  • It’s difficult to wake your child, or your child otherwise seems lethargic
  • You think your child is not drinking enough fluids
  • Your child seems very ill or irritable
  • Your child’s symptoms get worse, or don’t get better, after a few days
  • Your child’s rash doesn’t clear after 3 or more days

Contact a doctor immediately if:

  • Your child develops a febrile seizure
  • Your child shows signs of dehydration

Roseola vs. other causes of rashes

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

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

Reducing the risk of roseola

It may be difficult to reduce your young child’s risk of contracting roseola, but these hygiene practices may help keep your little one healthy and help curb the spread:

  • Wash your child’s hands (and your own hands) regularly
  • Keep your little one away from people who are coughing or sneezing

And if your little one is sick:

  • Regularly sanitize any toys and hard surfaces they touch
  • Keep them home, and limit their exposure to others, while they have a fever or other roseola symptoms

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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.