Measles in Children
Content reviewed against published CDC, AAP, WHO, NIH guidelines
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Measles is a highly contagious viral illness caused by the measles virus (a paramyxovirus). It causes a distinctive red blotchy rash, high fever, cough, runny nose, and conjunctivitis. Before vaccination, measles infected 3-4 million Americans annually. While now rare in the US due to MMR vaccine, outbreaks still occur in unvaccinated communities. Measles remains a leading cause of childhood death globally, killing over 100,000 children per year worldwide.
Key takeaways
- Measles is a highly contagious viral illness caused by the measles virus (a paramyxovirus).
- Duration: Prodrome (cough, fever, coryza) lasts 2-4 days. Rash appears around day 14 after exposure and lasts 5-6 days. Total illness lasts 7-10 days. Fever breaks 1-2 days after rash onset. Cough may persist 1-2 weeks.
- Go to ER if: Difficulty breathing or rapid breathing
- A vaccine or immunization is available
Symptoms
How It Presents by Age
0-6 months
Usually protected by maternal antibodies if mother is immune. If infected, can be severe. Fever, rash, and respiratory symptoms. High risk of complications.
Risk level: High if infected — partially protected by maternal antibodies
6-12 months
Maternal antibodies wane, making this a vulnerable period before MMR at 12 months. Presentation may be atypical or modified. Travel-related vaccine may be given at 6 months.
Risk level: High — too young for routine vaccination
1-5 years
Classic presentation with 3-5 day prodrome of fever, cough, coryza, and conjunctivitis, followed by rash spreading from face downward. Koplik spots appear 1-2 days before rash.
Risk level: Moderate to high — highest complication rate in under-5s
5-12 years
Classic measles if unvaccinated. Two doses of MMR provide 97% protection. Breakthrough cases in vaccinated children are milder.
Risk level: Low if vaccinated; high if unvaccinated
Treatment
Supportive care
No specific antiviral treatment. Management focuses on fever control, hydration, and rest. Measles is a reportable disease requiring public health notification.
Vitamin A supplementation
WHO and AAP recommend vitamin A for all children with measles. Reduces mortality and complication rates. Dose: 200,000 IU for children 12+ months; 100,000 IU for 6-11 months; 50,000 IU for under 6 months. Given on 2 consecutive days.
Fever management
Acetaminophen or ibuprofen for fever and discomfort. Adequate hydration is essential as high fevers increase fluid losses.
Complication management
Antibiotics only for bacterial superinfections (pneumonia, otitis media). Hospitalization for encephalitis, severe pneumonia, or dehydration.
Home Care
- Keep the child rested in a dimmed room (photophobia)
- Maintain hydration with frequent small sips of fluid
- Use a cool-mist humidifier for cough
- Gently clean eyes with warm wet cloths for conjunctivitis
- Serve soft, bland foods when fever allows eating
- Keep fever controlled with appropriate medication
- Isolate from unvaccinated household members
- Monitor for signs of complications closely
When to Worry
Go to the ER if:
- Difficulty breathing or rapid breathing
- Seizure or altered mental status
- Severe headache with stiff neck
- Signs of dehydration unresponsive to oral fluids
- Child appears extremely ill or lethargic
- Measles in an immunocompromised child
- Measles in an infant under 12 months
Call your doctor if:
- Suspected measles exposure in an unvaccinated child
- Fever with rash and cold symptoms (cough, runny nose, red eyes)
- Known measles contact — post-exposure prophylaxis may be available within 72 hours
- Ear pain developing during measles illness
- Cough worsening after initial improvement
- Decreased fluid intake
Keep an eye on:
- Fever returning after initial improvement (suggests secondary infection)
- Breathing difficulty or rapid breathing
- Drowsiness, confusion, or seizure
- Ear pain (otitis media complication)
- Persistent high fever beyond day 4 of rash
- Worsening cough or chest pain
Prevention
- MMR vaccine (measles, mumps, rubella) — first dose at 12-15 months, second dose at 4-6 years
- Two doses provide 97% protection against measles
- Post-exposure prophylaxis: MMR within 72 hours or immunoglobulin within 6 days of exposure
- Early MMR (6+ months) recommended for international travel
- Isolate infected individuals for 4 days after rash onset
- Maintain community vaccination rates above 95% for herd immunity
Contagion & Incubation
Incubation
7-21 days from exposure to rash onset (average 14 days). Fever typically begins around day 10.
Contagious for
Contagious from 4 days before rash onset until 4 days after rash appears. Most contagious during the prodromal period (before rash) when diagnosis is not yet suspected.
Duration
Prodrome (cough, fever, coryza) lasts 2-4 days. Rash appears around day 14 after exposure and lasts 5-6 days. Total illness lasts 7-10 days. Fever breaks 1-2 days after rash onset. Cough may persist 1-2 weeks.
Frequently asked questions
How long does measles in children last?
How does rubeola (measles) spread?
When should I take my baby to the ER?
Can rubeola (measles) 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
Measles in Children is a viral illness that typically resolves on its own. Seek emergency care if difficulty breathing or rapid breathing.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.