Fever, Rash, and Diarrhea in Young Children: A Guide for Parents

Fever, rash, and diarrhea in children?

My child will turn one at the end of August.
Last Saturday at 9 AM, he received two vaccinations for chickenpox and measles.
Before the shots, I felt that his temperature was slightly elevated, but I didn't measure it at that time.
After returning home and sleeping until 11 AM, his temperature felt even higher, and when I measured it, it was 38.5°C.
We then went to the clinic to get fever-reducing medication and observe him.
His temperature fluctuated between 37.x and 38.x, and when it exceeded 38.5°C, he showed signs of discomfort, occasionally sneezing and having a mild cough.
After Sunday, I could hear wheezing sounds from his nasal passages, but there was no nasal discharge.
On Monday, he had slight redness on his face and body (or small petechiae), and he experienced multiple episodes of diarrhea.
We visited the clinic, and the doctor diagnosed him with a cold and gastroenteritis, noting some redness and swelling in his tonsils.
On Tuesday and Wednesday, the rash increased (mainly on the face and torso, with very mild involvement of the arms and legs).
Since he was on medication, he had fewer episodes of diarrhea and fever.
On Wednesday night, he did not take his medication, and on Thursday morning, his temperature was again 38°C.
The rash appeared similar to Wednesday's, and his energy and mood were slightly lower than usual, but he could still play and interact.
It has now been six days.
I would like to know what to watch for in this situation.
Should we go to a larger hospital for further examination, or should we visit the clinic today and observe for a day or two before deciding over the weekend? What possible illnesses could be causing these symptoms? Thank you.

osminal, 30~39 year old female. Ask Date: 2011/09/08

Dr. Xiao Kaiwen reply Pediatrics

The following is a brief overview of diseases associated with fever and rash in infants and young children (refer to items 1, 2, 3, 4, 5):
1.
Measles
2.
Rubella
3.
Scarlet Fever
4.
Roseola Infantum
5.
Kawasaki Disease
Age of Onset:
1.
> 6 months
2.
> 6 months
3.
> 3-5 years
4.
6 months - 2 years
5.
6 months - 5 years
Family/School Cases (Outbreak Phenomenon):
1.
++
2.
+
3.
++
4.
±
5.
-
Cough and Runny Nose:
1.
++
2.
+ (Note 1)
3.
±
4.
±
5.
±
Conjunctivitis:
1.
++
2.
+ (Note 1)
3.
-
4.
-
5.
++
Cervical Lymphadenopathy:
1.
±
2.
++ (Note 1)
3.
±
4.
±
5.
++
Strawberry Tongue:
1.
-
2.
-
3.
+
4.
-
5.
+
Rash:
1.
Red maculopapular rash, tends to coalesce
2.
Red maculopapular rash, mostly non-itchy, lasts for 3 days
3.
Red itchy papules, resembling sunburn, feels like sandpaper
4.
Red maculopapular rash, mostly non-itchy
5.
Polymorphic rash, non-vesicular
Association of Fever and Rash:
1.
Rash appears 3-4 days after fever, both present for several days
2.
Both appear simultaneously
3.
Both appear simultaneously
4.
Rash appears after fever (Note 2)
5.
Rash appears after fever or simultaneously
Desquamation:
1.
Generalized rash with scaling, leaves brown pigmentation after resolution
2.
None
3.
Around fingers and anus
4.
None
5.
Around fingers
Mode of Transmission:
1.
Airborne/Droplet
2.
Droplet
3.
Droplet
4.
Droplet
5.
Non-communicable disease
Note 1: Rubella: 20-50% may be asymptomatic infections.

Note 2: Roseola Infantum: Occasionally, the temperature may normalize one day after the rash appears, or the rash may appear one day after the temperature normalizes.

It is evident that there are many possible diagnoses for infant rashes, and it is recommended to consult a pediatric infectious disease specialist at a major hospital for evaluation.

Reply Date: 2011/09/08

More Info

Understanding fever, rash, and diarrhea in young children can be quite challenging for parents, especially when these symptoms appear in conjunction with vaccinations. Your child's recent symptoms following the administration of the measles, mumps, and rubella (MMR) vaccine and varicella (chickenpox) vaccine warrant careful observation and understanding.

Firstly, it is important to recognize that mild fever and rash can be common reactions to vaccinations. The MMR vaccine, in particular, can cause a mild fever and a rash in some children about one to two weeks after vaccination. This is generally a normal immune response as the body builds protection against these diseases. However, the presence of diarrhea and other symptoms complicates the picture.

Given your child's symptoms—fever fluctuating between 37.x and 38.x degrees Celsius, mild cough, nasal congestion with wheezing sounds, and the development of a rash—there are several potential causes to consider:
1. Vaccine Reaction: As mentioned, the MMR and varicella vaccines can cause mild fever and rash. The rash may appear as small red spots or a generalized rash, which could be mistaken for other conditions.

2. Viral Infection: The symptoms you describe, including fever, cough, and diarrhea, could also indicate a viral infection, such as a common cold or a gastrointestinal virus. Viral infections are prevalent in children and can present with a combination of respiratory and gastrointestinal symptoms.

3. Roseola: This is a common viral infection in young children characterized by a sudden high fever followed by a rash. It typically occurs in children between 6 months and 2 years of age and could fit the timeline of your child's symptoms.

4. Hand, Foot, and Mouth Disease (HFMD): Caused by enteroviruses, HFMD can lead to fever, rash, and gastrointestinal symptoms. It is often accompanied by sores in the mouth and a rash on the hands and feet.

5. Allergic Reaction: Although less common, an allergic reaction to something in the environment or even to the vaccine itself could cause rash and other symptoms.

Given that your child has been experiencing these symptoms for several days, it is advisable to monitor her closely. Here are some guidelines on what to do next:
- Symptom Monitoring: Keep a close eye on her fever, rash, and overall behavior. If her fever persists above 38.5 degrees Celsius or if she shows signs of distress, lethargy, or difficulty breathing, seek medical attention promptly.

- Hydration: Ensure she stays well-hydrated, especially with diarrhea present. Offer fluids frequently to prevent dehydration.

- Medication: Continue administering any fever-reducing medications as prescribed by your doctor. Ibuprofen or acetaminophen can help manage fever and discomfort.

- Follow-Up: If her symptoms do not improve or if they worsen, it would be prudent to return to the clinic or visit a larger hospital for further evaluation. A healthcare provider may want to conduct tests to rule out any bacterial infections or other underlying conditions.

- Rash Evaluation: If the rash spreads significantly or changes in appearance, it should be evaluated by a healthcare professional to determine its cause.

In conclusion, while some of your child's symptoms may be related to the recent vaccinations, the combination of fever, rash, and diarrhea suggests that a viral infection could also be at play. Monitoring her symptoms and maintaining communication with your healthcare provider is key to ensuring her health and well-being. If in doubt, do not hesitate to seek medical advice.

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