🦠 Childhood Rashes & Communicable Diseases
Identified by what came before the rash, where it starts, and how it spreads — plus which isolation each one needs.
👀 The rashes, by signature
| Illness | Signature | Precautions |
|---|---|---|
| Measles (rubeola) | Koplik spots in the mouth first, then rash face downward; the 3 Cs — cough, coryza, conjunctivitis | AIRBORNE |
| Varicella (chickenpox) | Lesions in all stages at once — macule, papule, vesicle, crust. Intensely itchy | AIRBORNE + CONTACT |
| Rubella | Mild pink rash face downward; posterior cervical lymphadenopathy | Droplet |
| Fifth disease | “Slapped cheek”, then a lacy rash on the limbs | Standard once the rash appears |
| Roseola | High fever for 3–4 days, then the rash appears as the fever breaks | Standard |
| Scarlet fever | Sandpaper rash, strawberry tongue, strep throat | Droplet; needs antibiotics |
| Mumps | Parotid swelling; risk of orchitis | Droplet |
| Pertussis | Paroxysmal cough with an inspiratory whoop; vomiting after coughing | Droplet |
| Impetigo | Honey-colored crusts, usually around nose and mouth | Contact |
⭐ Airborne = “My Tiny Vampire”
Measles · Tuberculosis · Varicella — negative pressure room, door closed, N95.
Everything else on that table is droplet or contact.
🚨 The two absolutes
Never give aspirin to a child with a viral illness - Reye syndrome. Acetaminophen or ibuprofen instead.
Reye syndrome causes acute encephalopathy and liver failure, and it is associated with aspirin during varicella or influenza. This is why pediatric aspirin all but disappeared.
Untreated strep throat can become rheumatic fever and permanently damage heart valves. The whole antibiotic course must be finished, even once the child feels well.
Strep can also cause acute glomerulonephritis 1–3 weeks later — tea-colored urine and hypertension in a child who had a sore throat or skin infection.
🩺 Nursing care
✅ Varicella comfort
- Keep fingernails short; mittens for infants — scratching causes scarring and secondary infection
- Cool baths with oatmeal or baking soda; calamine lotion
- Antihistamines for itch; acetaminophen for fever
- Contagious from 1–2 days before the rash until all lesions have crusted
🧠 Fever management
- Treat for comfort, not for the number
- Light clothing, cool room, fluids
- No cold baths, no alcohol rubs - both cause shivering, which raises temperature
- Febrile seizures come from a rapid rise in temperature, not from how high it gets
💉 When to worry about a rash
- A purpuric or petechial rash with fever is meningococcal until proven otherwise. Emergency.
- A rash that does not blanch when pressed
- Rash with difficulty breathing, swelling of the face or tongue — anaphylaxis
- Rash with a stiff neck, severe headache or photophobia
🎯 NCLEX traps
- Koplik spots = measles. All stages at once = varicella
- Roseola: fever breaks, THEN the rash
- My Tiny Vampire for airborne
- No aspirin — Reye syndrome
- Finish the strep antibiotics — rheumatic fever
- Non-blanching rash + fever = emergency