Category: Health Library

The Myth of an Autism Epidemic

We hear stories about the rise in autism and the autism epidemic all of the time.

Autism prevalence rates have been steady at 1 in 68 since 2010.
Autism prevalence rates have been steady at 1 in 68 since 2010.

Every few years, the CDC had been releasing a new report which showed a higher prevalence of autism in the United States, including:

  • 1 in 150 children in 2000
  • 1 in 150 children in 2002
  • 1 in 125 children in 2004
  • 1 in 110 children in 2006
  • 1 in 88 children in 2008
  • 1 in 68 children in 2010
  • 1 in 68 children in 2012

Looking at those numbers, it is easy to see most people think that the rate of autism is rising.

And if the rate of autism is rising, then there must be a cause.

Thinking about it like that, it becomes easy to see why vaccines became the scapegoat for causing autism, especially after Andrew Wakefield told everyone that it “is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR…”

The Myth of an Autism Epidemic

Many experts don’t think that there is an autism epidemic though.

“…the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them.”

Emily Willingham

There are several different explanations for the apparent rise in the number of children being diagnosed with autism, including:

  • better recognition among health care providers
  • better recognition among parents
  • diagnostic substitution – children were once diagnosed with other conditions, such as mental retardation and learning disabilities
  • broadening of the criteria used to diagnose autism, including changes in DSM criteria, which went from labeling children with autism as having childhood schizophrenia (1952) and including just three essential features of infantile autism (1980) to adding PDD-NOS (1987) and more subtypes and symptoms to the autism diagnosis category in DSM-IV (1994).
  • social influences, including that more parents may have wanted to seek help when more resources become available and because they may have become more accepting of the possibility that their child had autism, leading them to seek a diagnosis and services. For example, before 1975 and the Education for All Handicapped Children Act, children with disabilities were excluded from school. And then in 1990, the Individuals with Disabilities Education Act (IDEA) included autism as a separate disability, making it a little easier to get services.

All together, these explanations help explain what has been confirmed by numerous studies, that the true prevalence of autism hasn’t changed over time.

What To Know About The Autism Epidemic Myth

There is no autism epidemic.

  • There are adults and older people with autism. Did you know that the the first meeting of the National Society of Autistic Children was held in 1965?
  • The idea that the ‘autism epidemic’ is a myth is not new – experts have been talking about it for over 10 years, which makes you wonder why some people still push the idea. An idea that hurts autistic families.
  • A 2015 study concluded that “Changes in reporting practices can account for most (60%) of the increase in the observed prevalence of ASDs in children born from 1980 through 1991 in Denmark. Hence, the study supports the argument that the apparent increase in ASDs in recent years is in large part attributable to changes in reporting practices.”
  • Autism is thought to be genetically based.

Some folks, especially those in the anti-vaccine movement, don’t want to believe that there is no autism epidemic though.

“If there is no autism epidemic, if there is a “stable incidence” of autism over recent decades, then this alone is powerful evidence against the vaccine hypothesis – and in fact removes the primary piece of evidence for a vaccine-autism connection.”

Steven Novella on The Increase in Autism Diagnoses: Two Hypotheses

After all, if there is no autism epidemic, then they can’t blame vaccines for be causing an autism epidemic…

More About the Autism Epidemic Myth

 

Reducing the Risk of Hot Car Deaths

Good Samaritan laws can offer protection if you help a child in a hot car in an emergency. Call 911 and get the child out of the hot car if you need to.
Good Samaritan laws can offer protection if you help a child in a hot car in an emergency. Call 911 and get the child out of the hot car if you need to.

In the United States, about 37 children die each year in hot cars.

Few are left in the car intentionally.

About half are accidents. Parents who forgot that the child was still in the car.

Many of the deaths are kids who got into the car and couldn’t get out.

All are tragic.

Kids in Hot Cars

How can you forget a child in a car?

Especially a car that might heat up to the point that a child can quickly die inside?

Although many people find it unbelievable that it can happen, it happens just the same.

People, once they are out of their very rigid routine, forget to drop a child off at daycare or that their child is still in the car.

“On days when the ambient temperature was 72°F, we showed that the internal vehicle temperature can reach 117°F within 60 minutes, with 80% of the temperature rise occurring in the first 30 minutes.”

Catherine McLaren on Heat Stress From Enclosed Vehicles

And remember, it doesn’t even have to be that hot outside for a car to quickly heat up.

How Hot Car Deaths Happen

It’s easy to see how some hot car deaths happen.

These are the deaths that are borne out of parental negligence. The kids who are left in a car while their parents party or shop.

But then you have the story of the mom who forgot to drop off her 7-month-old – dad usually drops her off – and doesn’t notice that she is still in the car until she picks up her son at daycare after work.

Or the child forgotten in a car after a family returns home.

Some deaths occur at daycare – kids left on a bus or van.

And sometimes kids get trapped in a car that had been unlocked.

Reducing the Risk of Hot Car Deaths

To help reduce the risk of these tragic hot car deaths, it might help to:

  • never leave your child alone in any vehicle, not even for a minute
  • lock your car and secure the keys so that your kids can’t get into your car and play by themselves
  • check the inside (after checking nearby bodies of water) of nearby vehicles, including their trunks, when a child goes missing
  • make sure your daycare provider alerts you if your child doesn’t show up
  • place reminders in the back seat with your child, so that even if you forget to drop off your child on the way to work, you will notice once you get to work and gather your things
  • bring your kids inside the house before anything else, so that you are less likely to get distracted and forget them outside
  • have a designated watcher if you have a lot of kids, especially if they are in multiple cars, to make sure everyone gets inside and no one is left in the car
  • call 911 if you see a child alone in any vehicle and get them out as soon as possible if they are not responsive or they are in distress
  • push for automakers to include standard devices in all cars to prevent hot car deaths

Most importantly, remember that it can happen to anyone, so be extra careful when you break your routine and always “look before you leave” or lock your car.

What To Know About Hot Car Deaths

Look before you lock and learn other way to reduce your child’s risk of a hot car death.

More About Hot Car Deaths

Safe and Effective Sun Screens for Kids

One of the cardinal rules of summer is that you don’t let your kids get a sunburn.

While a really great rule, it misses that you also shouldn’t let them get a tan either, and the rule doesn’t just apply to summer.

How do they do it in Australia? Slip (on some sleeves) - Slop (on a lot of sunscreen) - Slap (on a hat) - Seek (shade) - and Slide (on your sunglasses).
How do they do it in Australia? Slip (on some sleeves) – Slop (on a lot of sunscreen) – Slap (on a hat) – Seek (shade) – and Slide (on your sunglasses).

That’s were sunscreen comes in. Slop it on.

Sunscreens for Kids

Are sunscreens safe for kids?

As with insect repellents, despite all of the warning about chemicals and toxins that you might read on the internet, the answer is of course they are. In fact, most sunscreens can even be used on infants as young as age six months. And it is certainly better than letting your kids get sunburned!

You do have to use them correctly though.

Choosing a Safe and Effective Sunscreen

Which sunscreen should you use?

This Blue Lizard sunscreen includes Titanium Dioxide and Zinc Oxide, providing broad spectrum UVA and UVB protection.
This Blue Lizard sunscreen includes Titanium Dioxide and Zinc Oxide, providing broad spectrum UVA and UVB protection.

Many parents are surprised that there are actually a lot of different ingredients in sunscreens, from Aminobenzoic acid and Octocrylene to Zinc Oxide.

While some are physical sunscreens (Titanium Dioxide and Zinc Oxide), others are chemical sunscreens. Some provide UVA protection, some UVB protection, and some offer both. And not surprisingly, some have become controversial, especially retinyl palmitate (vitamin A) and oxybenzone.

All are thought to be safe though.

Which is best?

When choosing a sunscreen, start with the fact that none should usually be used on infants under six months of age. Otherwise, choose the product (whatever the brand, to be honest, whether it is Banana Boat, Blue Lizard, Coppertone, Hawaiian Tropic, Neutrogena, or Target) best suited to your child’s needs, especially considering that:

  • sun tan lotion and tanning oil should be avoided
  • SPF 8 only blocks 87 percent of UVB rays and should be avoided
  • SPF 15 blocks 93 percent of UVB rays (minimum you should use)
  • SPF 30 blocks 97 percent of UVB rays (good for daily use)
  • SPF 50 blocks 98 percent of UVB rays (good for daily use)
  • SPF 50+ don’t offer much more UVB protection and may encourage folks to stay in the sun longer than they should, putting them at even more risk from UVA rays
  • a broad-spectrum sunscreen provides both UVA and UVB protection
  • even if your kids don’t go in the water, a sunscreen that is water-resistant might stay on better if they are sweating or get sprayed with water

In addition to the active ingredient and it’s SPF, you can now decide if you want a sunscreen that is in a spray, mist, cream, lotion, or stick. You can then pick one that is fragrance free, PABA free (of course), tear free, oil free (important if your kids have acne), for your baby or your kid playing sports, for someone with sensitive skin, or goes on dry.

Using a whipped sunscreen is just one of the newer ways to protect your kids from the sun's harmful rays.
Using a whipped sunscreen is just one of the newer ways to protect your kids in the sun.

Or would you like your child’s sunscreen whipped???

While parents and kids often seem to prefer spray sunscreens, do keep in mind the warnings about inhaling the spray and that some experts are concerned that they make it harder to apply a generous amount on your child. How much of the spray goes off in the wind? How much end up in an oily spot on the floor? If you use a spray sunscreen, follow the directions, rub it in, and don’t spray it in your child’s face. Also, don’t spray sunscreen on your child near an open flame.

Most importantly, you want to choose a sunscreen that will help you get in a good routine of using properly and using all of the time. Personally, I like all of the newer non-greasy lotions for kids and adults that have come out in the last few years. They are easy to apply, even in generous amounts, and work well.

Using Sunscreens on Kids

Now that you have chosen your sunscreen, be sure to use it properly.

“An average-sized adult or child needs at least one ounce of sunscreen (about the amount it takes to fill a shot glass) to evenly cover the body from head to toe.”

FDA

Do your kids still get burned or tanned despite using sunscreen? They aren’t immune to sunscreen. You are probably just making one or more common sunscreen mistakes, like not using enough sunscreen (start using a lot more), waiting until you’re already outside before applying it on your kids (you want to apply sunscreen at least 15 minutes before you go outside so that it has time to get absorbed into their skin), or not reapplying it often enough (sunscreen should be reapplied every few hours or more often if your kids are swimming or sweating a lot).

How long does a 6 or 8 ounce container of sunscreen last you? Remember that if you are applying an ounce before your kids go outside, reapplying it every few hours, and using it on most days (not just in the summer), then it shouldn’t last very long at all.

A layered approach to sun protection can help keep your kids safe in the sun.
A layered approach to sun protection can help keep your kids safe in the sun.

For the best protection and to avoid mistakes, be sure to read the label and follow your sunscreen’s instructions carefully, and also:

  • encourage your kids to seek shade and wear protective clothing (especially hats, sunglasses, and UPF sun-safe clothing), in addition to wearing sun screen for extra sun protection
  • use sunscreen every time they go outside, even when it’s cloudy
  • reduce or limit your child’s sun exposure when UV rays are strongest, which is usually from about 10 a.m. to 2 p.m. (and all of the way to 4 p.m. in most areas), especially on days when the UV index is moderate or high and/or when there is a UV Alert in your area.

If you forget something, remember slip, slop, slap, seek, and slide.

Facts about Sunscreens and Sun Protection for Kids

Other things to know about sunscreen and sun protection for kids include that:

  • Waiting for improvements to sunscreen labels and new requirements for sunscreens? The FDA made their ‘big changes’ to sunscreens back in 2011. The main things that got left were the SPF cap and the rating system for UVA protection.
  • Tanning beds are not a safe alternative to getting a tan outside in the sun.
  • It is not safe to get a base tan. It won’t protect you from a sunburn and it increases your chance of future melanoma.
  • Still confused about how much sunscreen to use? Another handy rule is that a handful of sunscreen (fill to cover the palm of their cupped hand) should be a generous amount that’s enough to cover your child’s entire body. Since bigger kids have bigger hands, that should help you adjust the amount for different-size kids and as they get older.
  • Avoid combination sunscreen/insect repellent products. Use separate products instead, applying the sunscreen first and reapplying the sunscreen every few hours as necessary. Since you don’t typically reapply insect repellents (unless you are going to be outside for a really long time), if your child starts to get bitten, next time, you will likely need to consider using an insect repellent with a different active ingredient or at least one with a stronger concentration that might last longer.
  • SPF is only a measure of the sunscreen’s level of protection against UVB rays, but does say anything about UVA protection. A sunscreen that is labeled as being broad spectrum should protect against both UVA and UVB radiation.
  • According to the FDA, “SPF is not directly related to time of solar exposure but to amount of solar exposure.” What does that mean? While you can stay in the sun longer when protected with a sunscreen, no matter the SPF, it doesn’t tell you how long. Other factors, including the time of day, weather conditions, and even your location will help determine how quickly your skin will burn.
  • Sunscreens should be stored in a cool place and be thrown away after they expire. While it might be convenient, your car is not a good place to store your sunscreen.

Ready for some fun in the sun now? You sure you won’t come home with a sunburn or a dark tan?

What To Know About Sunscreens for Kids

Applying a generous amount of a water-resistant sunscreen that provides broad-spectrum SPF 15 to 30 sun protection at least 15 to 30 minutes before your child is going to be in the sun, reapplying every few hours, can help keep your kids safe in the sun.

More About Sunscreens for Kids

Incubation Periods of Childhood Diseases

The incubation period or latency period is the amount of time between being exposed to a contagious disease and when you begin developing symptoms.

This is not the same as the contagious period or the time during which your child can get others sick.

Incubation Period

Depending on the disease, the incubation period can be just a few hours or can last for several months. Knowing the incubation period for a disease can help you understand if your child is still at risk of getting sick or if he is in the clear — whether he is exposed to someone with strep throat, measles, or the flu.

“The incubation period is the time from exposure to the causative agent until the first symptoms develop and is characteristic for each disease agent.”

CDC

It can also help you figure out where and when your child got sick. For example, if your infant develops chickenpox, a vaccine-preventable disease, you can’t blame it on your cousin who doesn’t vaccinate her kids and who was visiting just three days ago. The incubation period for chickenpox is at least 10 to 21 days. So your child who is too young to be vaccinated likely caught chicken pox from someone he was exposed to a few weeks ago.

As we saw in recent outbreaks of Ebola and measles, a diseases incubation period can also help you figure out how long an exposed person needs to stay in quarantine. After all, if they don’t get sick once the incubation period is over, then they likely won’t get sick and can be released from quarantine.

Incubation Periods of Childhood Diseases

The incubation period for some common diseases includes:

  • Adenovirus – 2 to 14 days, leading to a sore throat, fever, and pink eye
  • vomiting after exposure to Bacillus cereus, a type of food poisoning – 30 minutes to 6 hours (short incubation period
  • Clostridium tetani (Tetanus) – 3 to 21 days
  • Chickenpox – 10 to 21 days
  • Epstein-Barr Virus Infections (Infectious Mononucleosis) – 30 to 50 days (long incubation period)
  • E. coli – 10 hours to 6 days (short incubation period)
  • E. coli O157:H7 – 1 to 8 days
  • Fifth disease – 4 to 21 days, with the classic ‘slapped cheek’ rash
  • Group A streptococcal (GAS) infection (strep throat) – 2 to 5 days
  • Group A streptococcal (GAS) infection (impetigo) – 7 to 10 days
  • Head lice (time for eggs to hatch) – 7 to 12 days
  • Herpes (cold sores) – 2 to 14 days
  • HIV – less than 1 year to over 15 years
  • Influenza (flu) – 1 to 4 days
  • Listeria monocytogenes (Listeriosis) – 1 day to 3 weeks, but can be as long as 2 months (long incubation period)
  • Measles – 7 to 18 days
  • Molluscum contagiosum – 2 weeks to 6 months (long incubation period)
  • Mycobacterium tuberculosis (TB) – 2 to 10 weeks (long incubation period)
  • Mycoplasma penumoniae (walking pneumonia) – 1 to 4 weeks
  • Norovirus ( the ‘cruise ship’ diarrhea virus) – 12 to 48 hours
  • Pinworms – 1 to 2 months
  • Rabies – 4 to 6 weeks, but can last years (very long incubation period)
  • Respiratory Syncytial Virus (RSV) – 2 to 8 days
  • Rhinovirus (common cold) – 2 to 3 days, but may be up to 7 days
  • Roseola – about 9 to 10 days, leading to a few days of fever and then the classic rash once the fever breaks
  • Rotavirus – 1 to 3 days
  • gastrointestinal symptoms (diarrhea and vomiting) after exposure to Salmonella – 6 to 72 hours
  • Scabies – 4 to 6 weeks
  • Staphylococcus aureus – varies
  • Streptococcus pneumoniae (can cause pneumonia, meningitis, ear infections, and sinus infection, setc.) – 1 to 3 days
  • Whooping cough (pertussis) – 5 to 21 days

Knowing the incubation period of an illness isn’t always as helpful as it seems, though, as kids often have multiple exposures when kids around them are sick, especially if they are in school or daycare.

Conditions with long incubation periods can also fool you, as you might suspect a recent exposure, but it was really someone your child was around months ago.

More About Incubation Periods

Treating Hard To Control Head Lice

Treating head lice probably never seems easy.

Washing your child’s hair with a head lice shampoo, washing things that had contact with your child’s hair, removing nits, and retreating your child in a week can be a hassle.

As you can imagine, it can be incredibly more frustrating when you can’t seem to get rid of the lice or they keep coming back.

Treatments for Head Lice

Although you could just manually remove all of the live lice on your child’s head and new lice as they hatch, most people choose to treat their kids with an over-the-counter head lice shampoo, such as:

  • Permethrin 1% lotion – Nix
  • Pyrethrins – Rid

If your community has a lot of problems with resistance to Nix or Rid (they don’t work), your pediatrician might recommend that your first choice be a prescription head lice treatment instead, such as Ovide (malathion), Natroba (spinosad), Sklice (ivermectin), or Ulesfia (benzyl alcohol).

Never initiate treatment unless there is a clear diagnosis with living lice.

AAP Clinical Report on Head Lice

While all of the prescription head lice treatments work well, Sklice has the added benefit that it should only require one treatment, and like Natroba and Ulesfia, can be used on infants as young as six months old.

Ovide works well, but is flammable because of its high alcohol content, can only be used on kids who are at least two years old, and some lice are already resistant to it.

Unfortunately, these prescription head lice treatments are much more expensive than Nix or Rid, although coupons can help with some of that expense. Of course, even Nix or Rid can quickly get expensive if you have to keep buying them over and over and over again because they aren’t really working.

Buying all of the things that parents sometimes do to prevent head lice, most of it not proven to work, can get expensive too.

Treating Hard To Control Head Lice

What do you do if your kids still have lice after they have been treated?

Ask yourself these questions and discuss the answers with your pediatrician:

  • Does your child really have lice?
  • Do you really see live lice moving around in the hours or days after you treated your child with an OTC head lice shampoo?
  • Do you just see dead or dying lice on your child’s head? Can you easily remove them?
  • Do you just see old nits on your child’s head?
  • Are you relying on natural or other home remedies to treat your child’s lice, such as essential oils, mayonnaise, or olive oil?
  • Do you see live lice about a week after you had treated your kids with an OTC head lice shampoo? Did you remember to do a second treatment to kill hatching eggs?
  • Are the live lice that you are seeing in the days after treatment very small and about the size of a pin head? These may be newly hatched lice. You can pick them off manually and know that any that remain will be killed when you do your second treatment. Ideally, any residue of the treatment left on your child’s head would have killed these newly hatched lice though.
  • Do you see live lice several weeks to months after you had treated your kids with an OTC head lice shampoo?
  • Are your kids continuing to share brushes or combs with other children?
  • Did you closely follow the instructions on the medication’s label?
  • Did you check other family members for head lice?
  • Have other infested children that are around your kids been checked and treated?
  • Are you at the point that you are considering shaving your child’s head?

While your kids may still have head lice after they have been properly treated with an OTC head lice shampoo, it is also possible that they don’t have an active head lice infestation anymore or that they simply got lice again. Getting reinfested is even more likely if you went weeks and weeks without seeing live lice and you don’t see many new nits yet. In that case, it is not that the OTC treatments are failing to work, it is that your kids keep getting new lice on their head.

Most importantly, remember that seeing live lice is the main sign to look for as to whether or not your kids need to be treated for an active head lice infestation. Simply having nits alone does not mean that your kids still have lice.

What To Know About Treating Hard To Control Head Lice

Treating your child’s head lice doesn’t have to be a nightmare, even when it seems like superlice are resistant to routine treatments.

For More Information On Treating Hard To Control Head Lice

Treating Hard to Control ADHD

ADHD is often much harder to treat than many people imagine.

It isn’t always just a matter of writing a script for Adderall or Ritalin and then have kids who had been failing suddenly jump to the ‘A’ Honor Roll.

ADHD Treatments

Whether your child’s ADHD symptoms include problems with inattention, hyperactivity and impulsivity, or both, the treatments are the same:

  • Stimulants – Adderall vs Ritalin based
  • Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera
  • Behavior Management Therapy

Although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

ADHD Medications

Surprisingly, there is really no one best ADHD medicine. Those that aren’t yet generic (in bold) are going to be much more expensive than the others.

  • Short Acting Stimulants – Adderall, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin
  • Intermediate Acting Stimulants – Dexedrine, Ritalin SR, Methylin ER
  • Long Acting Stimulants – Adderall XR, Adzenys XR-ODT, Concerta (Methylphenidate ER), Daytrana (patch), Focalin XR, Metadate CD, Metadate ER, Quillichew ER (chewable), Quillivant XR (liquid), Ritalin LA, Vyvanse
  • Non-Stimulants – Intuniv, Kapvay, Strattera

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

Treating Hard to Control ADHD

What do you do when your child’s ADHD treatments aren’t working?

While it is important to “initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity,” it is important to remember that not all kids with academic or behavioral problems have ADHD.

So the first thing you should do is confirm that your child really does have ADHD. Is it possible that your child was misdiagnosed and doesn’t have ADHD at all? Or could your child have ADHD and another co-morbid condition, including “emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.”

Next, ask yourself these questions and discuss the answers with your pediatrician:

  • Is your child taking his medicine?
  • Does your child need behavior management therapy?
  • Are you not getting your child’s ADHD medicine because of how expensive it is? Ask your pediatrician about a lower cost generic ADHD medicine.
  • Has there been a sudden worsening of previously well controlled ADHD, which might indicate a problem with bullying, social changes at home, abuse, or depression, etc.?
  • Are you relying on restrictive diets or other alternative treatments for ADHD that have been proven to not usually work?
  • Does your child need a different dosage of his current stimulant, either a higher or lower dose?
  • Is your child’s medication wearing off too soon?
  • Does your child’s medication take too long to work?
  • Does your child need to switch to a different stimulant or to a stimulant with a different delivery method?
  • Does your child need to switch from a long-acting stimulant to a short-acting stimulant?
  • Does your child need to switch to a non-stimulant, keeping in mind that these are often used in combination with a stimulant and not by themselves.
  • Do you need to adjust your expectations for what kind of control you can get from even maximal treatment?
  • Does your pre-teen or teen with ADHD not want to take his medication anymore?
  • Are side effects keeping your child from taking his ADHD medicine everyday?
  • Does your child need 504 plan accommodations at school and/or an IEP?

And perhaps most importantly, what is making your child’s ADHD hard to control? Is he just still having some ADHD symptoms or are those lingering ADHD symptoms causing an impairment? If they aren’t causing an impairment, such as poor grades, problems with friends, or getting in trouble at school, etc., then your child’s ADHD may be under better control than you think.

What To Know About Treating Hard to Control ADHD

ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.

More Information About Treating Hard to Control ADHD

What to Know About Fifth Disease

Fifth disease, also called erythema infectiosum, is a very common viral infection that most kids get in early childhood.

It got its name because it was the fifth disease that was known to cause a fever and rash.

Measles was the first.

Symptoms of Fifth Disease

Fifth disease can cause a child to look like they have slapped cheeks.
Fifth disease can cause a child to look like they have slapped cheeks. Photo by Dr. Philip S. Brachman

It is caused by parvovirus B19.

Symptoms start with a red rash on your child’s cheek, giving them the appearance that they have been slapped. And that’s where fifth disease’s other name comes from – slapped cheek disease.

This slapped cheek rash is often subtle, so that many parents might think that the rash is from the sun or wind. They often don’t even consider that their child might be ‘sick’ until a few days later, when they get a pink, lacy rash on their arms and legs. Even then, they might mistake the rash for hives, poison ivy, or any number of other common childhood rashes.

Diagnosis of Fifth Disease

Unless you understand that the fifth rash can come and go, being more obvious when your child is overheated, it can be easy to see why it isn’t quickly recognized by some people. It can also be confusing because the rash could also appear on a child’s back, chest, and leg – it doesn’t have to be limited to the cheeks and arms.

And the rash, which can be itchy, can linger for weeks or even months.

While a blood test can be done, it is this pattern of symptoms that makes the diagnosis.

Most importantly, understand that fifth disease eventually does goes away without treatment. While not usually necessary, anti-itch treatments may be tried.

Can your kids go to school with fifth disease?

Fortunately, kids are not contagious while they have this rash, so they can go to school and participate in other activities. You might need a note from your pediatrician to convince folks though. They were contagious during the week before they developed the rash though, so it can be a good idea to tell people, so they can look for symptoms too.

Facts About Fifth Disease

Other things to know about fifth disease include that:

  • Fifth disease is caused by the parvovirus B19 virus and is most common during the spring and school outbreaks are no uncommon.
  • The incubation period for fifth disease is very long – up to 4 to 21 days. That means you can get this virus about 4 to 21 days after being exposed to someone else that had it, especially if you were exposed to their respiratory secretions (coughing and sneezing) just before they developed their rash.
  • Prodromal symptoms of fifth disease, which can start 7 to 10 days before the rash, might include a few days of mild fever, muscle aches, headache and decreased activity.
  • In addition to a rash, adults with fifth disease can also have joint pain and arthritis.

It is also important to know that like roseola, fifth disease can be more serious for those with immune system problems. It can also be serious for pregnant women who aren’t immune and for those with hemolytic anemia and sickle cell disease.

What to Know About Fifth Disease

Fifth disease is a very common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

More Information About Fifth Disease