NG-377

🦠 Childhood rashes & communicable diseases

What each rash actually looks like, where it starts, which way it travels — and the precaution that goes with it.

⭐ The one idea

You tell these apart by three things: where the rash starts, what the individual spot looks like, and what the fever was doing beforehand. Get those three and the name follows.

🔍 Where each rash starts and which way it goes

🍱 Varicella — chickenpox

The giveaway is that every stage is on the skin at the same time. A flat spot, a raised spot, a blister and a scab, all in one square inch.

Precautions: Airborne and Contact — a negative-pressure room and an N95.
Contagious from 1–2 days before the rash until every lesion has crusted.
Comfort: cool baths, calamine, antihistamine, nails cut short and mittens on small children.

Never give aspirin to a child with chickenpox or influenza — Reye syndrome.

🌡 Roseola — the fever comes first

Three to five days of high fever in a child who otherwise looks well. Then the fever breaks, and only then does the rash appear.

The risk is in the fever phase, not the rash phase: a febrile seizure. Teach the parents what one looks like and what to do.

Standard precautions. The rash itself needs nothing.

🦠 The rest of the rashes, side by side

Disease	What you see	The clincher	Precaution
Rubella German measles	Pink maculopapular rash, face first then down; mild fever	Tender nodes behind the ears and at the back of the skull	Droplet
Mumps	Parotid swelling in front of and below the ear — the jaw angle disappears	Pain on chewing and with sour foods	Droplet
Scarlet fever group A strep	Fine red sandpaper rash; red lines in the skin folds; peeling later	Strawberry tongue and pale skin around the mouth	Droplet until 24 h of antibiotics
Scabies	Thin burrows and intense itch in web spaces, wrists, waist, axillae	Itching that is far worse at night	Contact
Rotavirus	Watery diarrhea and vomiting; no rash	Dehydration is the danger, not the virus	Contact
Conjunctivitis	Red eye; discharge tells you which kind	Crusted shut on waking = bacterial	Contact

🚨 The three that carry a warning beyond the rash

Rubella is teratogenic. Keep the child away from anyone who is or might be pregnant, and never give the vaccine during pregnancy.
Scarlet fever must finish the whole antibiotic course — untreated group A strep can go on to rheumatic fever or glomerulonephritis.
Mumps after puberty can cause orchitis. Also watch for stiff neck and hearing change.

🧼 Scabies — treating the house, not just the child

Permethrin from the neck down in an older child; include the head in infants.
Treat everyone in the household on the same day, whether or not they itch.
Wash bedding and clothing hot and dry hot; bag what cannot be washed.
Tell the family the itching can last two to three weeks after successful treatment — otherwise they think it failed and re-treat.

👁 Which conjunctivitis is it?

	Bacterial	Viral	Allergic
Discharge	Thick, yellow-green	Watery	Stringy, clear
On waking	Lids crusted shut	Wet, not stuck	Normal
Both eyes?	Often starts in one	Usually both	Always both
Other	—	With a cold	Itch is the main complaint

Wipe from the inner corner outward, one wipe per pass, separate cloth and towel per eye. Hand hygiene is the whole prevention.

😷 Airborne vs droplet vs contact

	AIRBORNE	DROPLET	CONTACT
Travels	Tiny particles that stay suspended	Heavy droplets that fall within a few feet	Touch — skin, surfaces, equipment
You wear	N95 (fit-tested)	Surgical mask	Gown and gloves
Room	Negative pressure, door closed	Private room, door may be open	Private room; dedicated equipment
Examples	Measles · Tuberculosis · Varicella	Influenza · pertussis · mumps · rubella · meningococcal · group A strep	MRSA · VRE · C. difficile · RSV · scabies · impetigo · rotavirus

🧠 Airborne = MTV. Measles, TB, Varicella. Everything else with a mask is droplet.

For C. difficile and any spore, wash with soap and water. Alcohol gel does not kill spores.

WHERE IT STARTS→ WHAT THE SPOT LOOKS LIKE→ PRECAUTION

NG-377 · Pediatrics unit · ADHD-friendly visual edition