Fifth Disease at Daycare: Slapped Cheek, Fever and Nights

Fifth disease (slapped cheek) usually starts like a cold: a low fever, a runny nose, a grumpy few days. Then it seems to pass, and a few days later the bright red cheeks arrive. Here is the part that surprises most daycare parents. According to the American Academy of Pediatrics, once the rash appears your child is no longer contagious, so the rash itself is rarely a reason to keep a baby home. The two things to act on are a fever in a young baby and anyone pregnant who has been around them.

The order it happens in

Parvovirus B19 causes fifth disease, and it tends to run in two acts. KidsHealth (Nemours) describes the opening as a low fever, a headache and a stuffy or runny nose. Those clear up, “and the illness seems to be gone until the rash appears a few days later.”

The rash comes in stages:

• The cheeks. A bright red rash on one or both cheeks: the “slapped cheek” look. The NHS notes it may be less obvious on brown and black skin.
• The body. A few days later a lighter, blotchy rash can appear on the chest, back, arms and legs. KidsHealth says it can be itchy and takes on “a lacy net-like look” after a few days.
• The fade. The AAP’s parent guide to fifth disease says the body rash usually goes away after about a week. The NHS puts the whole rash at 1 to 3 weeks.

One detail saves a lot of worry: the rash can come back. The AAP says it can reappear weeks or even months later when a child gets hot, for example during a bath. That is the same illness, not a new one. The AAP also notes that outbreaks are most common among preschool and elementary-age children, and that many people have mild symptoms or none at all.

Why daycare rarely sends a rash home

With pink eye at daycare, the rules varied from centre to centre. Fifth disease is much more consistent, because of when it spreads.

The AAP says a child “is most contagious in the first 5 days before the rash appears”, and that “once the rash appears, the person is no longer contagious.” KidsHealth says the same, and the NHS says children do not have to stay off school after the rash appears. So the contagious days are the ones that look like an ordinary cold, which is why the virus moves through a room before anyone has a name for it.

In practice, for the working parent:

1. The fever days follow your centre’s fever rule. That policy, not the rash, is what usually means a day at home.
2. The rash days are usually daycare days. Tell the centre it is fifth disease, and ask whether they want a note from your pediatrician. Some centres do.
3. Tell the staff. The centre will want to warn other families, and anyone pregnant on staff.

If a fever day catches you without cover, the club’s backup childcare plan takes one evening to set up.

If you’re pregnant, call your OB or midwife

This is the one part of fifth disease worth acting on the same day, for you, a pregnant teacher or a pregnant friend:

• The AAP says that “most times, fifth disease does not cause problems in pregnancy”. Rarely, an infection in the early stages can affect the baby’s red blood cells, leading to severe anemia and a risk of miscarriage.
• The CDC’s parvovirus B19 overview says it is important to seek care if you are pregnant and have been exposed.
• The NHS asks pregnant women to tell their midwife or GP if they have been near someone with slapped cheek.

Call your obstetrician or midwife and say your child, or a child in their room, has fifth disease. The AAP explains that a blood test for parvovirus B19 antibodies can show whether you are already protected from a past infection. If your own baby is the one diagnosed, the AAP asks you to tell any pregnant people who may have been exposed.

The same urgency applies to anyone, your baby included, with a blood disorder such as sickle cell disease or a weakened immune system. The AAP advises checking with the doctor at the first sign of the rash.

When to call the pediatrician

Fifth disease is usually mild, but the cold stage is still a fever in a baby, and fever rules come first:

• Under 3 months with a fever: the AAP says to call the doctor right away for a temperature of 100.4°F (38.0°C) or higher.
• Any age: the AAP’s fever call-the-doctor list includes a baby who looks very ill or unusually drowsy, a fever with an unexplained rash, or a fever lasting more than 24 hours in a child under 2.
• Rash-specific signs: the AAP says to reach out if symptoms seem to be getting worse rather than better, if you notice joint swelling, or if your child looks very pale.
• Emergency: the NHS fever page lists a rash that does not fade when you press a glass against it among its reasons to call 999, the UK emergency number. In the US, that’s 911.

On medicine: the AAP says your doctor may suggest acetaminophen for fever or aches. Ask the pediatrician or a pharmacist what suits your baby’s age and weight. KidsHealth and the NHS both say never to give a child aspirin.

The nights in between

The fever nights come first, while it still looks like a cold. The NHS advice translates simply to a crib:

• Keep feeds going. If you breastfeed, carry on as normal.
• Don’t pile on layers or extra bedding. The NHS also says not to undress or sponge a child to cool them.
• Check on your baby during the night, not only at bedtime. A basic digital thermometer like the Vicks SpeedRead saves a lot of guessing at 2 a.m.

The rash nights come later, when your baby feels fine but the skin flares. The NHS says the rash can last longer when a child is hot, and the AAP names a bath as a typical trigger, so keep the bedtime bath brief and lukewarm.

Safe sleep doesn’t change for any of it. That means back to sleep, on a flat, firm, bare surface, with nothing propped or added. Betteroo has a good walkthrough of what being unwell does to a baby’s nights: extra daytime sleep is fine, nights get bumpier for a few days, and you return to the usual expectations once your baby is well.

Not every fever-then-rash is fifth disease. With roseola, the other common fever-then-rash illness, the rash shows up as a high fever breaks. The AAP says pediatricians diagnose fifth disease mainly by looking at the rash. And if this is your baby’s first autumn in care, the daycare-start sleep crash post explains why the first months bring one bug after another.

Heard in the club: “The cheeks looked dramatic. The two cold days before them were the hard part, and the only call I needed to make was to my sister, who was twelve weeks pregnant.”

Nights back on track after a sick week Betteroo's free 3-minute quiz builds a sleep plan around your baby's age, so once the fever passes, bedtime has a routine to return to. Take the free sleep quiz →

FAQ

Can my baby go to daycare with fifth disease? Usually, once the rash is out, because the AAP says the child is no longer contagious by then. The earlier fever days fall under your centre’s fever policy.

How long is fifth disease contagious? The AAP says children are most contagious in the first 5 days before the rash, during the cold-like stage. By the time the cheeks turn red, they no longer spread it.

I’m pregnant and my child has slapped cheek. What should I do? Call your obstetrician or midwife. The AAP says most pregnancies are not affected, but a blood test can show whether you’re already immune, and your provider will decide on any further checks.

Does fifth disease need antibiotics? No. KidsHealth explains it is caused by a virus, so antibiotics don’t help. Rest, fluids and comfort are the treatment.