Fifth Disease (Slapped Cheek) in Babies & Children
Content reviewed against published CDC, AAP, AAP guidelines
Last reviewed:
Fifth disease is a mild viral illness caused by Parvovirus B19. It is called "fifth disease" because it was the fifth in a historical list of common childhood rash illnesses. Its hallmark is a bright red "slapped cheek" rash on the face, followed by a lacy rash on the body. Most children feel well once the rash appears. It is most common in school-age children but can affect toddlers.
Key takeaways
- Fifth disease is a mild viral illness caused by Parvovirus B19.
- Duration: Fever/cold phase: 2-5 days. Facial rash: 2-5 days. Body rash: 1-3 weeks (may come and go with heat/sun). Total: 1-3 weeks, with possible rash recurrences for weeks.
- Go to ER if: Child with sickle cell disease who develops fifth disease (risk of aplastic crisis)
- No vaccine currently available
Symptoms
How It Presents by Age
0-12 months
Uncommon in infants under 1 year. Maternal antibodies provide some protection. When it occurs, the rash pattern may be atypical.
Risk level: Very low
1-3 years
May have a milder presentation. Classic slapped-cheek rash followed by lacy body rash. Child usually feels well once rash appears.
Risk level: Very low
3-5 years
Classic presentation — mild cold symptoms for a few days, then bright red cheeks and lacy body rash. Often caught at preschool or daycare.
Risk level: Very low
5-15 years
Peak age for fifth disease. Full classic presentation. May have more noticeable cold symptoms before the rash.
Risk level: Very low
Treatment
No specific treatment
Fifth disease is mild and self-limiting. No antiviral medication is needed.
Symptom relief
Acetaminophen or ibuprofen if the child has fever or discomfort before the rash appears.
Itch relief
Antihistamines (diphenhydramine) or oatmeal baths if the body rash is itchy.
Sun protection
The rash may worsen or recur with sun or heat exposure, so avoid prolonged sun and hot baths.
Home Care
- Apply cool compresses to the cheeks if they feel warm
- Oatmeal bath if the body rash is itchy
- Keep the child out of direct sun (can worsen or reactivate rash)
- Avoid hot baths during the rash phase
- Offer fluids and rest if the child has fever (usually only before rash)
- Reassure — the rash looks dramatic but the child feels fine
- Loose, comfortable clothing to avoid irritating the rash
When to Worry
Go to the ER if:
- Child with sickle cell disease who develops fifth disease (risk of aplastic crisis)
- Severe pallor or signs of anemia (rapid heartbeat, extreme fatigue, shortness of breath)
- Very high fever with the rash (suggests a different diagnosis)
- Widespread rash that is purple/petechial (does not blanch) — not fifth disease
- Signs of severe allergic reaction
Call your doctor if:
- To confirm the diagnosis (especially if pregnant family members)
- Child with known blood disorder (sickle cell, thalassemia, spherocytosis) who may be exposed
- Rash is unusual, blistering, or not following the typical pattern
- Child seems unwell once the rash appears (should feel well)
- Pregnant woman exposed to fifth disease
- Joint swelling or significant pain
Keep an eye on:
- Rash lasting more than 3 weeks continuously
- Child with sickle cell disease or other blood disorder exposed to fifth disease
- Pregnant caregiver in contact with infected child
- Joint swelling in the child
- Child appearing pale or very fatigued
Prevention
- Handwashing (though prevention is difficult since contagious period is before symptoms)
- By the time the rash appears, isolation is not necessary
- Pregnant women should avoid known cases (though often exposed before diagnosis)
- No vaccine is available
- Once infected, immunity is lifelong
Contagion & Incubation
Incubation
4-14 days (up to 21 days)
Contagious for
Contagious during the week before the rash appears. Once the rash is visible, the child is no longer contagious.
Duration
Fever/cold phase: 2-5 days. Facial rash: 2-5 days. Body rash: 1-3 weeks (may come and go with heat/sun). Total: 1-3 weeks, with possible rash recurrences for weeks.
Frequently asked questions
How long does fifth disease (slapped cheek) last?
How does erythema infectiosum spread?
When should I take my baby to the ER?
Can erythema infectiosum be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Fifth Disease (Slapped Cheek) is a viral illness that typically resolves on its own. Seek emergency care if child with sickle cell disease who develops fifth disease (risk of aplastic crisis).
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.