Skin Rash in Children

Eczema, infection, allergy or something else?

Rashes are very common in babies and children. They can appear as red patches, bumps, blisters, dry or scaly skin, hives or spots.

The appearance can sometimes give clues, but a rash should not be diagnosed by appearance alone. The child's age, symptoms, distribution of the rash, how quickly it appeared and whether the child is otherwise well are all important.

Take a clear photo in good lighting if the rash changes quickly. This can be very helpful during a consultation.

Common Causes of Childhood Rashes

Atopic Eczema

One of the most common childhood skin conditions.

Typical features include:

• Dry, itchy skin
• Recurrent red or inflamed patches
• Scratching, especially at night
• Often affecting the face, body or skin folds depending on age

Eczema tends to come and go, with periods of flare and improvement.

Seborrhoeic Dermatitis

Common in babies, particularly during the first few months.

It may cause:

• Greasy or flaky scales on the scalp (“cradle cap”)
• Redness around the scalp, eyebrows, behind the ears or skin folds
• Usually less itchy than atopic eczema

It is generally harmless and often improves with age.

Viral Rashes (Viral Exanthem)

Many childhood viral infections can cause a rash, sometimes together with:

• Fever
• Runny nose or cough
• Sore throat
• Diarrhoea or vomiting

The rash may appear during or after the fever.

Bacterial or Fungal Infections

Impetigo

Some rashes are caused by infections, for example:

• Impetigo
• Cellulitis
• Fungal infections such as ringworm
• Other bacterial or viral skin infections

These may require specific treatment rather than just moisturisers or anti-itch medication.

Allergic Reactions

Allergic rashes may include hives (urticaria) — raised, itchy patches that can appear suddenly and move from one area of the body to another.

Possible triggers include:

• Foods
• Medicines
• Insect stings
• Infections
• Occasionally other environmental exposures

Hives do not always mean a food allergy; infections are also a common trigger in children.

When Should You See a Paediatrician?

Arrange an assessment if:

• The rash is persistent, recurrent or getting worse
• It is very itchy, painful, crusting or oozing
• Your child has significant eczema affecting sleep or daily activities
• There are recurrent hives or swelling
• The rash repeatedly occurs after eating a particular food or taking a medication
• There is fever or your child seems unwell
• You are unsure whether the rash is eczema, allergy or infection
• The rash is associated with poor growth or other ongoing symptoms
• our child has recurrent episodes of significant sore throat

What Happens During a Consultation?

The paediatrician will assess when the rash started, where it appeared, how it has changed, and whether it is itchy or painful, together with associated symptoms such as fever, cough, swelling or other signs of illness.

Most childhood rashes can be assessed clinically. Blood tests, allergy testing or other investigations are only needed when the history or examination suggests they may be helpful.