Scarlet fever and Group A Strep

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.

See general infomation below red, amber and green boxes


If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the rib or noisy breathing (grunting)
  • Breathing that stops or pauses
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does go away with pressure (see the 'Glass Test')
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red 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:

  • Unable to swallow saliva

  • Painful, red swollen neck glands

  • Painful, swollen joints

  • Puffy face or eyelids

  • Dark coca-cola coloured wee (urine)

  • Develops red lips or a red tongue

  • Develops a lot of skin peeling

  • Breathing a bit faster than normal or working a bit harder to breathe

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  •  Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Not using or putting weight on an arm, leg, hand or foot. 

  • Complaining of severe pain that is not improving with painkillers

  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

  • Getting worse or you are worried about them

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 your child has none of the above:

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 has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

Generally, scarlet fever is much less common than it used to be but in 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.

The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 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)

White Coating on Tongue.jpg

Scarlet Fever Face Rash.jpg

Scarlet Fever body rash.jpg

If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.

Scarlet fever last for around 1 week.  If you do not take antibiotics, you can spread the infection for 2-3 weeks after your symptoms start.


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. 


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

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