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Strep A and Scarlet Fever
Scarlet fever is an illness is caused by a bug called group A streptococcus, which is found on the skin and in the throat. Scarlet fever mostly affects children and can easily spread to other people.
Scarlet fever is much less common than it used to be but in the last few years there have been a number of outbreaks. It is important that children with Scarlet fever are assessed by a healthcare professional so that they can be started on antibiotics.
A Scarlet fever rash often begins with small spots on the body that spread to the neck, arms and legs over the one to two days. The rash may be harder to see on darker skin tones. It often feels like 'sandpaper' but is not itchy.
Your child may also have a:
- Sore throat or Tonsillitis
- Fever (temperature of 38oC or above)
- Painful, swollen glands in the neck
- A red tongue (strawberry tongue)
Photo credit: Skin Deep
If your child also has a runny nose with their tonsillitis, it makes a diagnosis of scarlet fever /Group A strep less likely.
Occasionally, Group A streptococcus can spread to other areas of the body, causing infections in the neck (tonsillar abscesses or lymph node abscesses), chest infections (pneumonia), bone and joint infections (septic arthritis) or sepsis.
When should you worry?
If your child has any of the following:
- Is pale, mottled and feels abnormally cold to touch
- Is going blue around the lips
- Too breathless to talk/eat or drink
- Has a fit/seizure
- Is extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Has dark green vomit
- Has a rash that does not disappear with pressure (the 'Glass Test')
- Is under three months of age with a temperature of 38°C/ 100.4°F or above (unless there is a fever within 48 hours of vaccinations and no other red or amber features)
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
- Is finding it hard to breathe
- Has laboured/rapid breathing or they are working hard to breathe – drawing in of the muscles below their lower ribs, at their neck or between their ribs (recession).
- Unable to swallow saliva
- Has features suggestive of scarlet fever (see above)
- Seems dehydrated (sunken eyes, drowsy or not passed urine for twelve hours)
- Is 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
- Has a painful, red swollen gland in their neck which is increasing in size
- Is three to six months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to two days after they receive vaccinations)
- Continues to have a fever of 38.0°C / 100.4°F or more for more than five 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 - dial 111
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, recheck that your child has not developed any red features.
If none of the above features are present
Additional advice is also available to young families for coping with crying of well babies – click here.
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
This guidance was last reviewed 26/03/2025.
What should you do?
- If you think your child has scarlet fever, they should be seen by their GP. They may need treatment with antibiotics.
-
Self-care-Many of the symptoms of scarlet fever can be relieved using some simple self-care measures, such as:
- drinking plenty of cool fluids
- eating soft foods (if your throat is painful)
- taking paracetamol to bring down a high temperature/distress
- using calamine lotion or antihistamine tablets to relieve itching.
- Avoid tepid sponging your child - it doesn't actually reduce your child's temperature and may cause your child to shiver.
How long will your child's symptoms last?
Scarlet fever last for around one week. If you do not take antibiotics, you can spread the infection for two to three weeks after your symptoms start.
Important
Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.
Scarlet fever is very contagious and can easily spread to other people. To reduce the chance of spreading Scarlet fever:
Do:
- Wash your hands often with soap and water
- Use tissues to trap germs from coughs or sneezes
- Bin used tissues as quickly as possible
Don’t:
- Do not share cutlery, cups, towels, clothes, bedding or baths with anyone who has symptoms of scarlet fever.
My child has been in close contact with someone with Strep A - do they need antibiotics?
If your child has been in close contact with a case of Scarlet fever or Strep throat, they do not need to be treated with antibiotics unless they are showing signs of an infection (severe tonsillitis with fever in the absence of a runny nose or signs of scarlet fever). Only in exceptional circumstances will the local public health team recommend for an entire school class to be treated with antibiotics.
Where should you seek help?
- If it is non-urgent speak to your local pharmacist or health visitor
- If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111
- You should only call 999 or go to your nearest A&E department in critical or life threatening situations
For wear and tear, minor trips and everything in between.
Self-care
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 can also 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?
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, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- 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 to the child and adolescent mental health services.
Contact them by phoning your Health Visitor Team or local Children’s Centre.
Sound advice
Health visitors also provide advice, support and guidance in caring for your child, including:
- Breastfeeding, weaning and healthy eating
- Exercise, hygiene and safety
- Your child’s growth and development
- Emotional health and wellbeing, including postnatal depression
- Safety in the home
- Stopping smoking
- Contraception and sexual health
- Sleep and behaviour management (including temper tantrums!)
- Toilet training
- Minor illnesses
For more information watch this video: What does a health visitor do?
School nurses care for children and young people, aged five to nineteen, 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 children and young people, with physical and/or emotional health needs.
Primary and secondary schools have an allocated school nurse. Telephone 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.
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, children 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.
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 straight away to the best service for you in your area.
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, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.