Group A Strep and Scarlet Fever

Group A Strep is a common type of bacteria. Most infections are mild and easily treated, but some are more serious. You can find out more on the NHS England website.

Scarlet fever, which is caused by the bacteria Group A streptococcus, is usually a mild illness but it is highly infectious. It is much more common in children than in adults.

It is important that children with scarlet fever are assessed by their GP so they can be started on antibiotics. This will reduce the chances of their infection becoming more severe and stops the infection spreading to others.

The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 days. It is often feels like ‘sand paper’ but is not itchy.

Sore throat or tonsillitis

Fever (temperature of 38°C (100.4°F) or above)

Painful, swollen glands in the neck

A red tongue (strawberry tongue)

If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.

Occasionally, the bacteria causing scarlet fever can spread to other areas of the body causing infections in the neck (tonsillar or lymph node abscesses), chest infections (pneumonia) or sepsis.

In addition, a small number of children experience complications in the week or two after recovering from scarlet fever. This can affect their kidneys (post-streptococcal glomerulonephritis) or their joints (post streptococcal arthritis).

If your child has any of the following:

  • Becomes pale, mottled and feels abnormally cold to touch
  • Is going blue around the lips
  • Too breathless to talk, eat or drink
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting
  • Has a fit, seizure
  • Becomes extremely agitated (crying inconsolably despite distraction)
  • Confused, floppy or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the ‘Glass Test‘)
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

Non-urgent advice: You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Is finding it hard to breathe
  • Unable to swallow saliva
  • Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours)
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) – especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Develops a painful, red swollen gland in their neck which is increasing in size
  • Is 3 to 6 months of age with a temperature of 39°C or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Continues to have a fever of 38.0°C  or more for more than 5 days
  • If your child has recently had scarlet fever but now appears to have a puffy face, eyelids, tea ‘coca cola’ coloured urine (pee), or a swollen, painful joint(s)
  • Is getting worse or if you are worried

Non-urgent advice: You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111

We recognise that during COVID, at peak times, access to a health care professional may be delayed. If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, then consider taking them to your nearest A&E

If none of the above features are present:

Additional advice is also available to young families for coping with crying of well babies – click here.


Non-urgent advice: Self-Care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 or contact your local community pharmacist

If you think your child has scarlet fever, they should be assessed by their GP. They may need treatment with antibiotics.

To make your child more comfortable, you may want to lower their temperature using paracetamol (calpol) or ibuprofen. If you’ve given your child one of these medications and they’re still uncomfortable 2 hours later, you could try the other medication. If this works, you can alternate paracetamol and ibuprofen (every 2 to 3 hours), giving only 1 medicine at a time. Do not give more than the maximum daily dose of either medicine.

However, remember that fever is a normal response that may help the body to fight infection and paracetamol/ibuprofen will not get rid of it entirely. Paracetamol and Ibuprofen bring down the temperature but do not treat the infection so whilst your child is unwell they will continue to get temperatures once the effects of the medication have worn off.

Avoid tepid sponging your child. It doesn’t actually reduce your child’s temperature and may cause your child to shiver.

Encourage them to drink plenty of fluids.

Good hand hygiene is important to stop the spread of bugs. Teach your child to wash their hands properly with soap for 20 seconds.

Use a tissue to catch coughs and sneezes. Keep away from others when feeling unwell.

The sore throat and fever often last for about 3 to 6 days and the rash usually improves within a week. Antibiotics reduce the length of fever/sore throat by about 1 day.

Children commonly experience peeling of their fingers and toes after scarlet fever.

Your child is no longer infectious to others (contagious) after 24 hours of starting antibiotics and can go back to school/nursery if they feel well enough.

If it is non-urgent, speak to your local community pharmacist

If your child has any of the above features, urgently contact your GP.

For an urgent out-of-hours GP appointment, call NHS 111.

You should only call 999 or go your nearest A&E department in critical or life threatening situations.