Slapped Cheek Syndrome: Symptoms, School and Pregnancy Advice
Slapped cheek syndrome is a common childhood virus (parvovirus B19). It starts like a cold, then causes bright red cheeks and a lacy rash on the body that fades within 1 to 3 weeks. Children are infectious only before the rash appears, so they can go to school once it shows if they feel well. It usually needs no treatment, but tell your midwife or GP if you are pregnant, or have a blood disorder or weak immune system, and have been in contact.
Bright red cheeks that look as if your child has been slapped, a few days after what seemed like a cold: that is the classic picture of slapped cheek syndrome. It is common, usually mild and gets better on its own. The things worth knowing are how to ease it, whether your child can go to school, and why a pregnant friend or relative should hear about it.
What is slapped cheek syndrome?
Slapped cheek syndrome, also called fifth disease, is caused by a virus called parvovirus B19. It is most common in children aged 6 to 10 and can spread quickly through a class. Adults can catch it too; it is rarer in adults but can be more uncomfortable, with joint pain.
The virus spreads through coughs and sneezes and by touching surfaces with the virus on them. Most people spread it before they know they have it, because the tell-tale rash only appears once they are no longer infectious.
Symptoms, stage by stage
- A few days of feeling unwell, like a cold: a high temperature, runny nose, sore throat and headache. This is when your child is infectious.
- A bright red rash on one or both cheeks. It can be less obvious on brown and black skin. Adults do not usually get the face rash.
- A few days later, a spotty or lacy rash on the chest, back, arms and legs. It can be raised and itchy, and harder to see on brown and black skin.
The rash usually fades within 1 to 3 weeks, but it can come and go for longer, especially when your child is hot, has been in a warm bath, is running around or is stressed. Joint pain and stiffness can happen, more often in adults, and can last for weeks.
Not sure what the rash is? The NHS has a guide to rashes in babies and children. Always get urgent help if a rash does not fade when you press a glass against it, or your child seems very unwell.
How to look after your child
There is no specific treatment and most children do not need to see a GP. To help them feel better:
- Let them rest.
- Give plenty of fluids. Babies should keep having their normal feeds.
- Give children’s paracetamol or ibuprofen if they are uncomfortable, following the dose on the packet for their age.
- Do not give aspirin to children under 16.
- For an itchy rash, loose cotton clothes and keeping them cool can help. A pharmacist can suggest something if itching is bothering them.
Can my child go to school or nursery?
Yes. Once the rash appears, your child is no longer infectious, so the NHS says there is no need to stay off school or nursery if they feel well enough. Do let the school or nursery know, as the NHS advises. It also helps them give a heads-up to anyone who is pregnant.
If you are pregnant
Many adults have already had parvovirus B19 as children: UK public health guidance estimates that at least half to two-thirds of pregnant women are already immune. But catching it in pregnancy, especially in the first 20 weeks, carries a small risk of miscarriage or of the baby developing severe anaemia. UK public health guidance says that infection in the first 20 weeks is linked to an increased risk of losing the baby, and that some babies infected between 9 and 20 weeks develop a serious fluid build-up called hydrops.
If you are pregnant and have been near someone with slapped cheek syndrome, or you get a rash yourself, tell your midwife or GP promptly. They can arrange a blood test to see whether you are immune or have a recent infection, and if needed, extra scans to keep an eye on your baby. Do not wait for your next routine appointment.
Cases rose sharply in England in 2024, reaching higher levels than the previous peak years of 2017 and 2018, according to UKHSA surveillance. Outbreaks come and go, so it is worth knowing the advice before it reaches your child’s class.
When to see a GP or get urgent help
See a GP if you or your child has slapped cheek syndrome and:
- you are pregnant
- you have a blood disorder such as sickle cell disease or thalassaemia, as there is a risk of severe anaemia
- you have a weakened immune system, for example because of chemotherapy, leukaemia, HIV or diabetes
Ask for an urgent GP appointment or contact NHS 111 if someone with slapped cheek syndrome has very pale skin, shortness of breath, extreme tiredness or has fainted. These can be signs of severe anaemia and may need hospital treatment.
Stopping it spreading
Because people are infectious before the rash shows, it is hard to stop slapped cheek going round a class. Good habits still help: wash hands often with soap and water, catch coughs and sneezes in tissues, and bin tissues straight away. There is no vaccine for parvovirus B19.
Dealing with an itchy rash on a baby instead? Our guide to nappy rash covers the most common one, and our guide to childhood allergies explains rashes that come with reactions.
Quick questions about slapped cheek syndrome
How long is slapped cheek contagious?
Only before the rash appears, during the cold-like stage. Once the red cheeks show, your child is not usually infectious.
How long does slapped cheek last?
The illness usually passes within 3 weeks. The rash normally fades in 1 to 3 weeks, although it can reappear when your child is hot.
Do I need to keep my child off school with slapped cheek?
No, not once the rash has appeared, as long as they feel well. Tell the school so they can let any pregnant staff know.
Is slapped cheek dangerous in pregnancy?
It is usually mild, but infection in the first 20 weeks carries a small risk to the baby. Tell your midwife or GP if you have been in contact or develop a rash.
Can adults get slapped cheek syndrome?
Yes, although it is less common. Adults rarely get the red cheeks but often have joint pain and stiffness.
