Introduction

Doctors today refer to it as parvovirus infection or erythema infectiosum. Some people may call it slapped-cheek disease because of the face rash that develops resembling slap marks. Parvovirus infection is also commonly called fifth disease because it was fifth of a group of once-common childhood diseases with similar rashes. The other four are measles, rubella, scarlet fever and Dukes’ disease.

Whatever the name, parvovirus infection is still a common but mild infection in children that generally requires little treatment. However, parvovirus infection in some pregnant women can lead to serious health problems for the fetus. Parvovirus infection is also more serious for people with certain anemias or with a compromised immune system.

Signs and symptoms

Early phase of parvovirus infection
Most children with parvovirus infection feel well. Some develop mild, cold-like signs and symptoms early in the illness, and these initial parvovirus symptoms typically last five to 10 days. They may include:

• Sore throat
• Slight fever
• Upset stomach
• Headache
• Fatigue
• Itching

Following phases

• Several days later, a distinctive bright red facial rash usually appears on both cheeks.
• Eventually, the rash may extend to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance.

Generally, the rash occurs near the end of the illness. It’s possible to mistake the rash for other viral rashes or a medicine-related rash. Infants and toddlers develop the same signs and symptoms as do school-age children. The rash may come and go for up to three weeks, becoming more visible when a child is exposed to extreme temperatures or spends time in the sun.

In adults
In adults, the most prominent symptom of parvovirus infection is joint soreness (arthralgia), lasting days to weeks. Joints most commonly affected are the hands, wrists, knees and ankles.

Asymptomatic parvovirus infection
Parvovirus infection can also occur without any signs or symptoms in either children or adults.

Causes

The human parvovirus B19 causes parvovirus infection. This isn’t the same as the parvovirus seen in dogs and cats, so you can’t get the infection from a pet or vice versa.

Parvovirus spreads from person to person, just like a cold, often through respiratory secretions and hand-to-hand contact. The illness is contagious in the week before the rash appears. Once the rash appears, the person with the illness is no longer considered contagious and doesn’t need to be isolated.

Parvovirus B19 is most common among elementary school-age children during outbreaks in the winter and spring months, but anyone can become ill with it anytime of the year.

When to seek medical advice

For your child
If your child develops what appear to be signs and symptoms of parvovirus infection, but you’re not sure, contact your doctor to see if there may be some other cause for the signs and symptoms. Also contact your doctor if your child has a temperature greater than 102 F (38.9 C) or if you have other concerns.

If you have anemia
If you have sickle cell disease or a similar type of chronic anemia, parvovirus infection can lead to severe anemia. See your doctor for treatment. Once the infection is under control, the anemia will get better.

If you’re pregnant
If you’re pregnant and you suspect you’ve been exposed to parvovirus, see your doctor. A pregnant woman with parvovirus infection may pass the illness along to her baby. Although the great majority of pregnant women who have parvovirus infection will deliver normal, healthy children, there’s a small risk to the unborn baby of severe and even life-threatening health conditions.

If your immune system is weak
Also, see your doctor for help with treatment if you have a weakened immune system, perhaps because of another preexisting disease, cancer treatment or an organ transplant.

Screening and diagnosis

If a rash is present, your doctor may be able to make a diagnosis by examination. About half of adults are immune to parvovirus infection, most likely because of a previous, unnoticed, childhood infection.

If you’re pregnant or if you’re an adult with a compromised immune system, blood tests can help determine if you’re immune to the infection or if you’ve recently become infected. The blood tests commonly used are tests for antibodies that are specific for parvovirus infection. Subsequent action depends on test results:

• If the blood tests indicate immunity, you don’t need to be concerned. You can’t be reinfected.
• If the tests confirm evidence of recent parvovirus infection, you may need additional testing to determine what, if any, complications — such as anemia — need treatment.
• If you’re pregnant and you have parvovirus infection, your doctor may perform additional tests, such as ultrasound and possibly additional blood tests, to watch for potential fetal complications.

Complications

Complications related to pregnancy
If you’re pregnant and you become infected with parvovirus B19, particularly during the first half of your pregnancy, there’s a chance your baby may develop serious complications, such as severe anemia. But this occurs in only a small percentage of infected pregnant women.

Fetal anemia can cause congestive heart failure in your baby, manifested by a severe form of edema — swelling of body tissues due to excessive fluid — called fetal hydrops, which may lead to miscarriage. If you have parvovirus infection, your doctor may monitor your pregnancy with ultrasound examinations for the possible development of fetal complications.

The fetal anemia, congestive heart failure and edema can improve over several weeks. Your doctor may suggest steps to try to correct these problems. Possible approaches include a blood transfusion directly to your fetus or giving you medications that pass through your placenta to your fetus.

Most pregnant women with parvovirus infection have normal, healthy babies. Parvovirus infection doesn’t increase the risk of birth defects or mental retardation.

Other complications in adults
Other complications in adults include the following:

• If you have sickle cell anemia or other types of anemia in which red blood cells are used up faster than your bone marrow can replace them, parvovirus infection can lead to severe anemia.
• If you have a weakened immune system, particularly if you’ve undergone chemotherapy, signs and symptoms of the infection can be severe, requiring medical care.

Treatment

For a noncomplicated parvovirus infection, sufficient parvovirus treatment generally consists of self-care steps at home. The rash itself doesn’t need treatment.

If you have severe anemia you may need to be hospitalized and receive blood transfusions. If you have a weakened immune system you may receive antibodies (via immune globulin) to treat your infection.

If you’re pregnant and develop parvovirus infection, your doctor may monitor possible effects on your baby. Treatments may include blood transfusions and medications if your baby has anemia, congestive heart failure or edema.

Prevention

There’s no vaccine to prevent parvovirus infection. Once you’ve become infected with parvovirus, you acquire lifelong immunity. Washing your hands and your child’s hands frequently may help diminish the chances of getting an infection. Throw away used tissues immediately after use — and wash your hands after handling them.

Self-care

Self-care treatment is aimed primarily at relieving signs and symptoms and easing any discomfort. Make sure you or your child gets plenty of rest and drinks lots of fluids. You can use acetaminophen (Tylenol, others) to relieve temperatures of more than 102 F (38.9 C) or minor aches and pains. Avoid giving aspirin to children. Aspirin may trigger a rare but potentially fatal disorder known as Reye’s syndrome.

It’s impractical and unnecessary to isolate your sick child. You won’t know your child has parvovirus infection until the rash appears, and by that time, your child is no longer contagious.

Nightmares are a nearly universal experience for young children. A few kids experience more-intense scary dreams known as night terrors.

Kids who have nightmares typically wake up frightened and look for reassurance, eager to share vivid details of their scary dreams. Kids who have night terrors may scream and thrash about, but remain sound asleep. They probably won’t remember anything about the night terrors in the morning.

Night terrors are relatively rare, affecting only a small percentage of kids — often between ages 4 and 12. However frightening, night terrors aren’t usually cause for concern. Most kids outgrow night terrors by adolescence. In the meantime, your calming presence and gentle reassurance can help your child get a good night’s sleep.

Signs and symptoms

Night terrors occur during deep sleep, usually two to three hours after a child goes to sleep. Your child may shriek loudly, sit up in bed, thrash about or even charge blindly around the bedroom or through the house. Your child may be sweating or breathing fast. Still, your child is fast asleep. If you try to hold or comfort your child, he or she may fight you.

Night terrors often last for a few minutes, or sometimes longer. When your child wakes, he or she probably won’t remember anything about the episode.

Causes

Various factors can contribute to night terrors, including:

• Fatigue. Night terrors are more likely when a child is overly tired.
• Stress. For some kids, problems at home or school or other stressful events trigger night terrors. Sleeping in a different room or away from home may have the same effect.
• Illness. Sometimes being sick triggers night terrors, especially if the illness is accompanied by a fever.
• Medications. Medications that affect the brain or spinal cord might trigger night terrors.

Risk factors

Night terrors tend to run in families.

When to seek medical advice

Occasional night terrors aren’t usually cause for concern. You can simply mention your child’s night terrors at a routine well-child exam. Consult your child’s doctor earlier if the night terrors:

• Become more frequent
• Routinely disrupt your child’s sleep
• Appear to follow a nearly identical pattern
• Lead to dangerous behavior or injury
• Are accompanied by other signs or symptoms

Screening and diagnosis

Night terrors are usually diagnosed at home. The doctor may do a physical or psychological exam to identify any conditions that may be contributing to the night terrors. If your child hurts himself or herself during night terrors, the doctor might want to observe your child in an overnight sleep lab.

Complications

Night terrors themselves aren’t necessarily a concern, but sometimes a child having a night terror can hurt himself or herself. If frequent night terrors disrupt your child’s sleep, excessive daytime sleepiness might be a problem. Sometimes sleepiness leads to school or behavior problems.

Treatment

Treatment for night terrors isn’t usually necessary. If your child has a night terror, simply wait it out. You might gently restrain your child and try to get him or her back into bed. Speak softly and calmly. Shaking your child or shouting may only make things worse.

If the night terrors are associated with an underlying medical or mental health condition, treatment is aimed at the underlying problem. If stress or anxiety seems to be contributing to the night terrors, your child’s doctor may suggest meeting with a therapist or counselor.

Medication is rarely used to treat night terrors. If necessary, however, short-term use of benzodiazepines may help reduce night terrors. If night terrors are affecting your child’s performance in school or other daily activities, an antidepressant may help.

Self-care

If night terrors are a problem for your child, be patient while you get to the root of the problem — or simply wait it out.

• Safety counts. If your child has frequent night terrors, make sure his or her bedroom is safe. Skip the bunk beds, and consider blocking doorways or stairways with a gate. Place any sharp or fragile objects out of reach.
• Put stress in its place. If your child seems anxious or stressed, talk about what’s bothering him or her.
• Encourage relaxation. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed.
• Take bedtime seriously. Fatigue can contribute to night terrors. If your child isn’t getting enough sleep, try an earlier bedtime or a more regular sleep schedule.
• Look for a pattern. Night terrors tend to occur at the same time of night. To disrupt the cycle, it might help to wake your child about 15 minutes before you expect a night terror.

Above all, be positive. However disruptive, night terrors aren’t a serious condition — and they usually go away on their own.