Understanding Childhood Rashes: A Pediatrician’s Advice for Parents

If you have ever looked at a red, bumpy, itchy rash on your child’s skin and wondered, “Is this normal?” you are not alone. It can be hard to know which rashes need medical care and which ones can be treated at home. Thankfully, Lauren Strelitz, MD, a pediatrician at Stanford Medicine Children’s Health – Pediatrics in Pinole has some tips to help you figure out the best way to deal with rashes. She also discusses this in a HealthTalks podcast.

What is a rash?

Rashes can be tricky because they often look alarming: red, inflamed skin or rough, bumpy patches. Sometimes they are itchy too. Scratching only makes rashes worse but try telling that to a toddler or preschooler! Understanding more about rashes can help you determine the next step.

“A rash is basically just any change of texture or color of the skin. And some rashes have no symptoms. It’s just something you see. And then other rashes can be itchy or painful,” Dr. Strelitz said. “I think kids probably get a lot of rashes that they don’t come to the doctor for. But the most common rashes that I see are either eczema or a viral exanthem, which is a type of rash caused by a viral infection.”

Common causes of rashes

Eczema is a chronic condition that usually needs ongoing care, while viral rashes usually go away on their own unless caused by certain viruses, such as herpes, which may need treatment.

“Most rashes don’t require any treatment unless it’s a viral rash like herpes, which you would treat with an antiviral medication the child would take by mouth,” Dr. Strelitz said. “Eczema flares definitely require treatment, but one of the goals with eczema is to try to prevent the rash from coming by identifying triggers. This is not always possible, though, because even things like weather changes can trigger eczema.”

When should you see a pediatrician for a rash?

While many rashes are harmless, some require a doctor’s evaluation. Dr. Strelitz explained that if a rash lasts more than a couple of weeks, feels itchy or painful, or is getting worse, you should check in with your pediatrician. Additionally, some rashes are associated with illness. So, a doctor should take a look if your child isn’t feeling well or has a fever, or if the rash is spreading.

“If it’s painful, they should not wait. They should always see a doctor if it’s painful. If the rash is persistent, lasting longer than one to two weeks, that would definitely be a reason to see a doctor, even if it’s not bothering the child. Although there are many persistent rashes that are totally benign and don’t need a treatment, your child still should get evaluated,” she said.

“If it’s bothering the child, like if it’s itchy, that would also be a reason to see a doctor. And, of course, with the more severe rashes, like if your child is sick, or getting worse, or the rash is getting bigger, those are reasons to see a doctor.”

Treating a rash at home

According to Dr. Strelitz, most mild rashes can be treated at home with some simple changes in skin care.

“If it’s itchy, eliminating any possible allergens like scented soaps, scented detergents, dryer sheets, fabric softeners can help. And then apply a petroleum-based ointment to replace that oil barrier and to soothe the skin,” she said. “You can also try over-the-counter topical hydrocortisone, but you shouldn’t use that for more than a week without seeing the doctor.”

Dr. Strelitz advises parents to lock in the skin’s moisture, but not all moisturizers are created equal. She recommends skipping lotions and opting for plain creams or ointments (like Vaseline) without added ingredients.

“You have to be careful with lotion because lotion is 60% water. When you rub the lotion onto the skin, the water evaporates, and it pulls the moisture from the skin with it. In some people, particularly people with eczema, lotion can actually make the skin drier,” she said. “Lotions also commonly have fragrances, which are a really big trigger for contact and atopic dermatitis, eczema. I think creams are better than lotion, but ointments (a smooth oily preparation that is rubbed on the skin) are the best for dry skin.”

Trust your instincts

If you are worried about your child’s rash, or just have questions about it, Dr. Strelitz recommends reaching out to your pediatrician.

“If you’re just not sure and you want to get checked out, you don’t need a reason to see the doctor,” she said. “We’re always happy to see a child and to advise you.”

For more advice from Dr. Strelitz, see Pink Eye in Kids: What Parents Need to Know or Beat the Heat: Keep Kids Safe in the Autumn Sun.

To learn more about rashes, read Rashes Caused by Viruses or Noninfectious Skin Conditions.