Allergic reactions. Viruses. Sun exposure. There are dozens of reasons why your child may suddenly break out in a rash. These outbreaks of bumps, hives, redness, or scaly areas on the skin can be swollen, itchy, and even painful. If they are not cared for properly, they may become inflamed or infected.

Most rashes will go away in about a week. But if your little one’s rash spreads or becomes uncomfortable, make an appointment with your pediatrician. If you notice any red flags like difficulty breathing, wheezing, or facial swelling, visit the closest emergency room or call 911.

It is understandable to be alarmed when the skin breaks out. But rashes are a normal and usually harmless reaction — they’re a sign the body has body has encountered something foreign or irritating.

“Children tend to get rashes more than adults because they are being exposed to allergens, viruses, and bacteria for the first time,” says Elisabeth Rogers, DO, a pediatrician at Summit Health. “They also tend to be less hygienic. Kids often do not wash their hands properly, so they pick up germs and irritants more easily.”

There are a few main reasons why children break out in rashes. Viruses, allergens, eczema, and bacterial or fungal infections are the most frequent causes. 

Viral Illness

You expect to see fever, body aches, or a stuffy nose when your child has a virus. But did you know that rashes are also a common sign?

The appearance and location of the rash will vary. Depending on the virus, it may look like hives, redness, or small pimply bumps. The rash may appear at the same time as flu-like symptoms or once the illness begins to resolve.

Common viral rashes include:

• Hand, foot, and mouth disease (coxsackie) — flat red spots that generally appear on the extremities.
• Fifth disease (slapped cheek disease) — a raised bright-red area, often on the face.
• Roseola (sixth disease) — small pink spots that usually start on the chest or back.

Treatment for viral rashes: “There is really nothing you can do for these rashes. They are benign, and you do not need to worry about them,” says Dr. Rogers. “They will go away on their own, but it may take a little time.”

Allergic Reactions

Another major cause of rashes in children is an allergic reaction. An allergen is a substance that enters the body and triggers an inflammatory response. Kids are often allergic to food, plants, insect bites, soaps, or fragrances. A rash may appear anywhere from a few minutes to a couple of hours after the child is exposed to the allergen.

Rashes brought on by allergies typically look like hives. Also known as welts or wheals, these raised, red, and round bumps are usually very itchy. Hives may appear anywhere on the body, but most commonly on the neck, arms, and chest.

Common causes of allergic rashes include:

• Food — Hives tend to break out shortly after a child ingests what they are allergic to, like peanuts, eggs, or milk.
• Poison ivy — Red bumps may turn into blisters in the area that came in direct contact with the plant.
• Antibiotics — Nearly 1 in 15 people are allergic to some type of antibiotic, most commonly penicillin. A reaction usually appears after one or two doses of medication but could occur anytime during treatment. If your child develops a rash, do not have them take another dose. Call your pediatrician immediately so they can change the medication.
• Heat rash (also known as prickly heat) – This is not an allergic rash, but rather a skin condition caused by blocked sweat ducts. These small, pimple-like spots are caused by prolonged sweating or exposure to the sun.

Treatment for allergic reactions: “If this is the child’s first exposure, I would suggest giving an antihistamine and monitoring their symptoms. Topical steroid cream can be used to control itchiness. In severe cases, when the child is very uncomfortable, oral steroids can be used to control the inflammation,” advises Dr. Rogers.

Note: Watch carefully for other systems in the body that may be affected. If your child begins to wheeze, cough, have difficulty breathing, become nauseous or vomits, or they develop swelling in the tongue or face, visit the closest ER or call 911 immediately. These are signs of a life-threatening allergic reaction known as anaphylaxis, and an EpiPen is usually needed to help improve breathing and reduce swelling.

Bacterial and Fungal Infections

Other pediatric rash triggers include various strains of bacteria and fungi in the environment. Children have less-developed immune systems and are notorious for picking up germs and other tiny organisms.

Common causes of bacterial and fungal infections are:

• Impetigo — This contagious skin infection presents with red sores and blisters on the face. Sports with skin-to-skin contact can spread this bacterium.
• Ringworm — Caused by a fungus, this circular, ring-shaped rash usually has a clear center. Children often pick up ringworm by walking barefoot in a locker room or near a swimming pool.
• Athlete’s foot — A peeling, cracked, scaly, or itchy rash starts between the toes.

Treatment: “Bacterial infections like impetigo require antibiotics, so the child will need to be seen in the office,” says Dr. Rogers. “If a fungal rash does not respond to over-the-counter creams, make an appointment so your pediatrician can prescribe a stronger medication.”

Eczema

Also known as atopic dermatitis, this condition causes the skin to be red, dry, scaly, and itchy. The exact cause of eczema is unknown, but it is thought to be a combination of an overactive immune system, allergies, the environment, and genetics. Eczema is extremely common in children.

Treatment for eczema: “Hydration is really the key, so the main treatment is simply moisturizing the skin. Topical steroids may also be used,” says Dr. Rogers.

Tips for Parents

Evelyn Rodriguez-Zierer, MD, a pediatrician at Summit Health, understands how alarming it can be when your little one breaks out in a rash. The first steps, she says, are to identify the cause, help the child feel more comfortable, and watch for any red flags. Follow these helpful tips the next time you notice a rash.

1. Take a picture. Rashes often fade by the time the child comes in for an appointment. “If the rash is changing, take additional photos,” notes Dr. Rodriguez-Zierer. “Marking the borders is also a good idea, so you know if the rash begins to spread.”

2. Look for other symptoms. Is your child itchy and uncomfortable, or are they happily playing with their toys? Is the rash confined to a particular body area, or is it everywhere? Aside from the rash, is your child experiencing any other symptoms? These are the first questions Dr. Rodriguez-Zierer asks her patients.

3. Clean the area. “Wash the affected area with a mild skin cleanser and lukewarm water,” advises Dr. Rodriguez-Zierer. “Pat the area dry to avoid further irritation caused by friction.” 

4. Identify the cause. Did your child eat a new food? Were they outside in the woods? Have they been sick? Answering these questions will help you connect the dots that led to the rash.

5. Use over-the-counter aids. Oral antihistamines can control the symptoms of an allergic reaction. Cortisone cream can also be applied to reduce inflammation and itchiness. “If the rash is itching or burning, you can apply a cold compress to reduce swelling and inflammation,” says Dr. Rodriguez-Zierer. “An oatmeal bath also relieves itching.”

6. Make an appointment. Dr. Rodriguez-Zierer urges patients to come in for a visit if the rash is associated with any of the following:

• Fever or other systemic symptoms (sore throat, headache, vomiting, diarrhea, etc.)
• Covers the entire body
• Progressively enlarging or multiplying
• Causes moderate to severe discomfort
• Does not improve in two to three days
• Looks like a bruise without a history of trauma
• Located in or around sensitive areas like the eyes, ears, mouth, and genitals
• Signs of an allergic reaction or bacterial infection

7. Visit the ER or call 911 in the case of life-threatening symptoms. Seek immediate medical attention if your child begins to wheeze, cough, have difficulty breathing, become nauseous or vomits, or they develop swelling in the tongue or face. These could be signs of a life-threatening allergic reaction.