Slap Cheek 2017

Slap cheek is one of those illnesses that seem to come around a couple of times a year. I have seen a number of patients with it this week, so it appears that it is starting to make the rounds.

This virus is also known as Fifth disease or Erythema Infectiosum. (Fun fact - it got the name Fifth disease back in the 1880s when childhood diseases that caused rashes were referred to by a number. This was number 5 out of 6. Others on that list included measles and scarlet fever.) This one is caused by Parvovirus B19.

Just like Hand Foot Mouth, Slap Cheek is a fairly contagious rite of passage. It is mostly spread through respiratory secretions, but can also be carried through infected blood. Most people get it while they are still children (usually between 4-15) and thus have immunity as adults.

Unless we had a bad case of it most of us don't actually know whether we have had it. You can check with Grandma, but I bet she doesn't remember either. The symptoms may have been mild enough that no one paid much attention. This illness can be quite variable. Some kids don't seem too impaired while others are miserable. The really mild cases can present with a child who has a red chappy cheek for a day or so, and that's it! The sicker kids can be achy (joint pain is common for those old enough to voice their complaints) and fussy with high fevers on and off for several weeks. The common denominator (hence the name) is one or both cheeks usually appear very red and chappy. For most patients, the red cheeks are followed by a lacy, mottled rash that works its way up and down the body.  It tends to cover the arms and legs more than the trunk. (Of course there are exceptions; some kids don't read the textbooks and present any which way that they like.) There may be several days in between symptoms. Some kids look flushed when they have a fever no matter what, so red cheeks aren't definitive. This diagnosis has some guessing involved.

Very rarely kids can get quite ill with this. In my many years here, I have NEVER had any patients who didn't get over it completely and without any lasting adverse effects, so relax, but remember Nurse Judy's rule; any fever that is lasting 4 or 5 days needs to be checked on.

I will reiterate one of my common statements. When your child is sick you have a choice. Are you mostly feeling sorry for your poor little one who is clearly feeling crumby or are you deeply concerned about them. If you are really worried, regardless of what we think is going on, it is absolutely worth having your child checked out. Four out of five of my patients with high fevers might have slap cheek, but that fifth might be the one with strep throat. 

The most important thing to note about slap cheek is that it can be dangerous to a fetus. If a woman is infected in the early stages of pregnancy there is an increased chance of miscarriage. Keep in mind, most women had this as a child and are therefore not at risk. But since most people also don't really know if they had it or not, It is best to avoid contact with pregnant women as much as possible if your child has been diagnosed with slap cheek. If you are pregnant and may have been exposed, talk to your OB about getting a blood test to check your immunity.

The incubation period is thought to be about 4-21 days after the exposure. (In other words if you come into our office and walk out with a red cheek, you didn't get it here; that would be way too soon.)

The kids are most contagious at the very beginning of the illness when the main symptom is probably simple fussiness. The cheeks might be red, but you reasonably figure that this could simply be caused by being a little warm. Frankly, by the time the rash is in full throttle they are probably not very contagious anymore. Often patients have some congestion as part of the package.

Treatment is symptomatic. Treat the fevers as needed with Tylenol/ Ibuprofen and tepid baths. Make sure your child gets plenty of fluids and rest as needed.

My best daycare, camp and school guidelines are to keep a child home if they are fussy or have a fever, but if you have a happy child with a red cheek, it seems unreasonable to expect you to stay home from work. Chances are, once one of the kids in daycare shows up with it, everyone has already been exposed.

This virus can cycle on and off for a few weeks before it is done with  you.

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