Slapped cheek syndrome: Everything you need to know about the condition

Slapped cheek syndrome is one of the most common conditions in children, it can often be difficult to spot. Here's what to look out for...

Close up picture of a child's who has slapped cheek syndrome
(Image credit: Alamy Stock Photo)

Slapped cheek syndrome is a common condition that affects babies and children, giving them a hot red flushed cheek on one side of their face - or both. Slapped cheek can easily it can often be difficult to spot or is easily confused with other illnesses.

Cases of slapped cheek syndrome are most common between the ages of four and 12. However, babies and older children can also get it. The National Institute for Health and Care Excellence (NICE) describes (opens in new tab) slapped cheek syndrome as a viral infection caused by parvovirus B19. It is usually defined by a red rash on children’s cheeks. Although other symptoms are similar to those of a common cold, such as a high temperature, runny nose, and sore throat.

NHS GP Thuva Amuthan (opens in new tab) explains: "Slapped cheek syndrome typically starts with the cheek, as the name suggests, and can move onto the body. You may feel unwell for the first few days with a temperature, runny nose, sore throat and headache."

Medical researchers (opens in new tab), descibe slapped cheek syndrome as “usually a mild self-limiting illness in children”. However, adults can also get slapped cheek syndrome and although harmless for most, it can be serious if you are pregnant.

Slapped cheek syndrome symptoms

  • Distinctive face rash
  • Runny nose 
  • Sore throat 
  • Headache 
  • Temperature
  • Joint pain and stiffness (usually just in adults)

Slapped cheek syndrome, which is also sometimes referred to as 'cheek slap rash' or 'face slap syndrome', has a number of symptoms. The most common, of course, is the distinctive face rash that gives it its name. However, you should also be on the lookout for other symptoms, as listed above.

In many ways slapped cheek syndrome may appear to be similar to a common cold. Children will sometimes also display a high temperature of 38C or more with it. However, it is the rash that most parents will usually notice first. In general, a slapped cheek rash is not painful.

Dr Chun Tang (opens in new tab), GP at Pall Mall Medical, says: “This may appear at first as a bright red rash on one or both cheeks and will generally just remain there. In some cases, it can also spread to the rest of the body. A few days after appearing on the face, a lighter coloured rash can appear on the chest and tummy, back, the arms, the legs, the palms of the hands and the soles of the feet.”

It can often be frightening when a rash appears on your child, but unlike the more worrying meningitis (opens in new tab) rash, a slapped cheek rash will fade if pressure is applied to it. (You can always do the glass test (opens in new tab) recommended by Meningitis Now to test this.)

Dr Amuthan, who is also the founder of Dr.Derme (opens in new tab) clinics, explains: "Our biggest worry with anyone with a temperature and rash is, of course, meningitis. "If when pressed against a tumbler the rash does not disappear or you feel unwell, you must seek urgent medical attention. Many other viruses can also cause a similar rash."

The NHS (opens in new tab) also has a helpful guide to rashes in babies and young children. However, as a parent, you know your child better than anyone and you should always trust your own judgment. If you are at all in doubt about the rash or have concerns about your child, you should contact your GP or call the NHS on 111. If your child is unresponsive or floppy, call 999.

Despite these common slapped cheek syndrome symptoms, around one in four cases have no symptoms at all. This means that it can sometimes be tricky to spot. Adults are also less likely to get a rash. Dr. Tang explains: “In adult cases of slapped cheek, someone may experience joint pain and stiffness. This may continue for a few weeks even after other symptoms have gone.”

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Slapped cheek syndrome treatment

  • Rest
  • Drink plenty of fluids
  • Take paracetamol or ibuprofen for high temperatures (do not give aspirin to under 16s)
  • Use moisturiser or children’s antihistamines on itchy skin

The best slapped cheek syndrome treatment is the same as for many other viral infections: rest and lots of fluids to avoid dehydration. It should get better on its own within three weeks. However, if your little one has a high temperature you can give them children’s paracetamol or ibuprofen to bring it down.

Unlike bacterial diseases, viral diseases such as flu, chickenpox, measles (opens in new tab), and shingles (opens in new tab), are not treatable with antibiotics. This means that while you can take treatment to relieve some of the symptoms, you must rely on your body to fight the actual infection. According to the British Society for Immunology (opens in new tab), the body can do this in a number of ways, including by producing antibodies.

While viral diseases, such as slapped cheek syndrome, are sometimes uncomfortable, they normally do not cause serious issues for healthy people.

Dr. Tang advises: “Have plenty of rest and lots of fluids. For a sore throat or high temperature, children’s paracetamol or ibuprofen can ease flu-like symptoms.”

However, if you or your child is at risk of complications from viral diseases, for example from a chronic disease or a suppressed or compromised immune system, you should call your GP or the NHS on 111. This is also the case if you are pregnant.

If you still feel unsure about what is the best treatment, check with your pharmacist or doctor.

What causes slapped cheek syndrome?

Slapped cheek syndrome is caused by a viral infection. It typically spreads via saliva and mucus. Its incubation period (the time between the initial infection and the appearance of symptoms) is usually between 4 and 21 days. This is why it can often spread easily through childcare facilities such as nurseries and schools. It is sometimes also informally called ‘cheek slap rash’ or ‘face slap disease’ and is caused by parvovirus B19.

According to researchers (opens in new tab) from the Institute of Tropical Medicine of Sao Paulo, the first known picture of a patient with the condition was recorded in 1808. It is also sometimes referred to as the ‘fifth disease’ because historically it was classified as the fifth of the classical childhood skin rashes, after measles, scarlet fever (opens in new tab), rubella and Dukes' disease.

Slapped cheek syndrome is most common in young children. However, it can occur at any age. It is estimated that 6 in 10 adults have been infected at some point.

Dr. Tang says: “Generally slapped cheek syndrome is not an infection to worry about. So you usually don’t need to see a GP. “The majority of people who get the virus don’t even know they’ve had it and it clears up without leaving any complications. However, if you are pregnant, have a blood disorder, or a weakened immune system, you should always see your doctor if you suspect you’ve caught the virus.”

How long does slap cheek last?

When slap cheek symptoms occur the infection has actually already been in the body for anywhere between 4 and 20 days. When the rash does appear, the person with it is no longer contagious. However, it can sometimes take up to a month for the cheek slap rash to disappear.

Dr. Tang explains: “A cheek and body rash normally fades within a few days to two weeks. But the body rash can remain longer if the child is hot.”

Other factors which can cause the rash to last longer include being anxious, stressed or doing exercise.

Also, adults with slapped cheek syndrome may experience joint pain and stiffness. This can occasionally happen in children too but is rare. However, the joint pain can continue for many weeks afterward, even after the other symptoms have gone.

Can you go to school with slapped cheek syndrome?

It is fine to attend school with slapped cheek syndrome. Due to the fact it is actually contagious before the rash appears, most people will be unaware they have it. Once the rash shows it is no longer infectious, so children can go to school or nursery. However, you should make your child’s teacher aware, so that they can alert other parents that there is a case in the class.

Dr. Amuthan says: "Once the rash develops children should no longer be infectious so they do not need to stay at home.

"However, it is important you inform the school or nursery, as they should avoid contact with anyone at risk from complications such as pregnant women or children and adults who are immunocompromised."

It is also fine to attend work as an adult, although likewise, you should inform your line manager and colleagues.

slapped cheek syndrome

Jessica Ojala/Getty

How contagious is slapped cheek syndrome?

Slapped cheek syndrome spreads in the air when we cough, laugh, and sneeze. It can also be passed by saliva droplets in the air when we are in close contact with others. That’s why when children get it, it can spread very rapidly through a nursery, classroom, or school.

“Slapped cheek syndrome is only contagious before the rash appears. So it often spreads before it’s apparent that a child has it,” says Dr Tang.

To reduce the risk of spreading slapped cheek syndrome:

  • Wash hands often with warm water and soap
  • Use tissues to trap germs from coughing or sneezing
  • Throw away used tissues immediately 

Parvovirus B19 is similar to the parvovirus that affects cats and dogs. However, it cannot spread from human to animal or vice versa.

Slapped cheek syndrome in pregnancy

The main time to be concerned about slapped cheek syndrome is during pregnancy. This is because if you get the infection for the first time while pregnant it can increase the risk of miscarriage. This is especially the case during the early part of pregnancy. You should alert your GP immediately if you have slapped cheek syndrome in pregnancy. However, most pregnant women go on to have healthy babies after slapped cheek syndrome.

According to information (opens in new tab) from the National Institute for Health and Care Excellence (NICE): "Complications of parvovirus B19 infection are rare in healthy people.”

However, it warns that this is not the case for pregnant women and people who are immunocompromised or have hematological disorders, who are at increased risk of serious complications.

Dr. Amuthan explains: "In the majority of cases when pregnant women develop the condition, the baby is fine. However, it can lead to loss of the baby or conditions that affect the blood, heart or liver of the baby. In severe cases, the mother can also develop swelling. If you are pregnant try to avoid contact with anyone that may have encountered the virus. They can be infectious up to 10 days before the rash appears. If you are unsure please seek medical attention."

If you are pregnant and think you may have slapped cheek syndrome, contact your doctor as soon as possible. This is so that your baby can be monitored. They will then arrange for a blood test to check for antibodies in your body. If you are in the early stages of pregnancy, you will be monitored by ultrasound.

If you’re unsure if you or your child has slapped cheek syndrome, it’s always best to seek medical advice.

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Emily-Ann Elliott
Health and family writer

Emily-Ann Elliott is an experienced online and print journalist, with a focus on health, travel, and parenting. After beginning her career as a health journalist at The Basingstoke Gazette, she worked at a number of regional newspapers before moving to BBC News online. She later worked as a journalist for Comic Relief, covering stories about health and international development, as well as The Independent, The i, The Guardian, and The Telegraph. Following the birth of her son with neonatal meningitis, Emily-Ann has a particular interest in neonatal health and parental support. Emily-Ann has a degree in English literature from the University of Newcastle and has NCTJ and NCE qualifications in newspaper journalism.