Scarlet fever in children: symptoms, causes and treatment
Dr. med. Christine Stettner
May 25, 2026
5 min
Scarlet fever is a widespread bacterial infection that mainly affects children. It typically causes a red rash, high fever and a sore throat. In this blog post, you will learn everything you need to know about the causes, symptoms and course of scarlet fever, as well as the treatment options. We sat down with Dr Christine Stettner, an experienced paediatrician, to give you a concise overview.
What causes scarlet fever and how is the disease transmitted?
Scarlet fever is an infectious disease caused by the bacterium Streptococcus pyogenes and often occurs in children between the ages of 6 and 12. It is usually transmitted via droplet infection. When speaking, coughing or sneezing, the pathogens are released into the air in very fine droplets. These are inhaled by other people and colonise the mucous membranes in the throat, where they cause inflammation.
What are the typical symptoms of scarlet fever and how do I recognise the disease in my child?
After infection with streptococci, swelling and reddening of the tonsils with or without a whitish coating and a bright red palate occur after one to seven days - occasionally with small haemorrhages ("petechiae"). The lymph nodes in the neck are often enlarged and painful. The children suffer from severe sore throats, sometimes with a high temperature. This is also referred to as "streptococcal angina".
In the case of scarlet fever, a so-called strawberry tongue and a sandpaper-like, fine-spotted skin rash also develop after one to two days. This usually begins in the groin, armpits and neck. Pale skin around the mouth is also typical. From the second week of the disease, the skin on the hands and feet often starts to peel.
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How is scarlet fever treated?
The primary treatment is symptomatic, i.e. children should be given sufficient painkillers. These mainly include ibuprofen and paracetamol. Throat sprays and lozenges can also be offered. It is also important that children drink enough.
In some cases, antibiotic treatment is also necessary: for example, if the child is in a reduced general condition, can no longer swallow or has severe pain when swallowing, or if there is no improvement after four to seven days. In these cases, a throat swab should be taken before starting treatment.
The same applies to children with pre-existing conditions such as heart defects, diabetes, kidney disease and immunocompromised children.
When can children return to kindergarten or school?
This depends solely on the clinical condition of the child. However, the usual hygiene measures must be observed with particular care. No specific preventive measures are recommended.
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