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Scarlet fever and Group A Strep

Red symptoms

Amber symptoms
Green symptoms
What should I do?
How long will symptoms last?
Useful links


scarlet fever rash

There are currently high rates of Group A Strep and scarlet Fever in NI. 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 should be assessed by a Doctor so that they can be started on antibiotics.

This is not only to reduce the chance of their infection becoming more severe but also to stop them spreading the infection to others, especially people at higher risk of severe infection such as the elderly and those with weakened immune systems.

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

Your child may also have

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

images of scarlet fever rash and tongue

If your child has a runny nose with their tonsillitis, it makes a diagnosis of scarlet fever / Group A strep less likely. Most children with Group A Strep throat infection or scarlet fever will get better with antibiotics. Unfortunately, very 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.  You can read more about spotting the signs of sepsis here.

As a parent if you feel that your child seems seriously unwell or is becoming more unwell even if they are on treatment or have recently finished antibiotics, you should trust your judgement.

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).

Find out more about the signs of Group A Strep on the PHA website.

Red Symptoms

Please also see symptoms for fever/high temperature and sore throat.

Check if your child has any red symptoms:
  • Persistent high fever
  • Severe muscle aches
  • Widespread erythematous ‘sunburn like’ rash
  • Localised severe muscle tenderness
  • Increased pain, swelling and redness at site of a wound, particularly chicken pox lesions
  • Unexplained severe diarrhoea and vomiting
  • Becomes pale, mottled and feels abnormally cold to touch
  • Has a dark green vomit
  • Is going blue around the lips
  • Too breathless to talk / eat or drink
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Seems dehydrated or has not passed urine in 12 hours.
Actions to take if your child has any red symptoms
  • Your child may require emergency treatment.
  • You should call 999 or take them to your NEAREST Emergency Department where they can be assessed.

Amber Symptoms section

Please also see symptoms for fever/high temperature and sore throat.

If there are no red symptoms, check if your child has any amber symptoms:
  • Sandpaper rash – red, bumpy rash
  • Sore throat and fever
  • Skin infections
  • Is getting worse or you are worried
  • If your child has recently had scarlet fever but now appears to have puffy eyelids/face, tea / ‘coca-cola’ coloured urine (pee), or a swollen, painful joint(s)
Options if your child has any amber symptoms

Your child does not need to be taken to the Emergency Department immediately, but you should seek medical advice today.

You can:

  • ring your GP surgery during their usual opening hours
  • contact the out of hours GP if the surgery is closed

If symptoms continue for four hours or more and you have not been able to speak to your GP or the out of hours GP, consider going to your nearest Emergency Department. 

If your child develops any of the red symptoms above, go to your nearest Emergency Department.

Green Symptom image

If no red or amber symptoms are present:
  • your child does not seem to have any symptoms of serious illness or injury
  • you can get general advice on the NI Direct website or from your local pharmacy

If your child develops any of the red or amber symptoms above, follow the advice in these sections.

What should I do?

  • If you think your child has scarlet fever, they should be assessed by by their GP. They may need treatment with antibiotics
  • To make your child more comfortable, you may want to lower their temperature using paracetamol and or ibuprofen. Use one and if your child has not improved 2/3 hours later you may want to try giving the other medicine. However, remember that fever is a normal response to fight infection and paracetamol/ ibuprofen may not get rid of it entirely
  • 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 and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections.

How long will symptoms last?

  • A sore throat and fever often last about 3-6 days and the rash usually improves within a week.
  • 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 / nursery if they feel well enough.

Useful links

More information on Strep Glomerulonepritis
Paediatric Sepsis