Strep A and scarlet fever symptoms – from toddlers to big kids, what should we know?

We recently covered Group A strep – often referred to as GAS, strep A or Group A streptococcus – and the signs and symptoms to watch out for in your child. 

With global rates increasing, and some confusion around strep A and scarlet fever – are they the same thing or do they come with different symptoms? – we’re unpicking both, for you to refer back to as we head into winter. 

Is strep and scarlet fever the same thing?

Not exactly. Scarlet fever is caused by Group A streptococcus, which is a type of bacteria. 

Scarlet fever is very infectious, but it’s also usually a mild illness, and much more common in children than in adults. 

First things first, if you’re worried about your child or a child in your care, speak to a healthcare professional as soon as possible so that diagnosis and treatment can kick-start the recovery process. 

How are the symptoms different? 

It’s important to remember that strep A is the cause behind a case of scarlet fever. 

Strep A symptoms include: 

• sore throat and fever
• yellowish-white spots at the back of the throat (tonsils), and sometimes red spots at the top of the mouth (roof or palate) 
• neck pain or tender lumps (lymph nodes) in the neck 

If strep A causes a child to develop scarlet fever, symptoms also include: 

• a sandpaper-like rash 
• very red lips and/or a red tongue

In rare cases, complications can include: 

• difficulty breathing 
• dehydration
• joint and limb pain
• tender skin, with a redness which spreads quickly 

This NHS Foundation Trust page gives a helpful checker with what to do next, for each symptom. 

Why are toddlers and young children more at risk?

Group A strep has been in our environment for a long time, and most adults and older children will already have been exposed to it. 

Many of us will even carry strep A around with us, without noticing any symptoms. Very young children and toddlers – usually under 5 years old – may not have had the same levels of exposure as yet. And, crucially, following the lockdowns navigated during and after Covid-19, exposure may be even lower for this group. 

Health professionals and organisations believe this is a leading cause of the sharp increase in strep A and, as a result, scarlet fever cases we’re now seeing in toddlers and young children. 

Bear in mind that toddlers (and of course, babies) often find it very difficult to articulate discomfort – especially where the pain and soreness is, for example, or feelings of dehydration. More obvious, visible signs are fever, rash and changes to lips and tongue, or breathing difficulties. 

So if your child is out of sorts, be vigilant and always get advice from a healthcare professional if you’re at all concerned. We recommend printing out the symptoms to watch for and recommended next steps, and pinning them on the fridge (or somewhere prominent), and saving to your phone. 

How can we be proactive?

Previous viral infections often weaken the body, making it harder to shake off an opportunistic bacterial infection like strep A. To be proactive and get ahead of the infection, tick off these top tips: 

• ensure your child’s immunisations are all up-to-date
• book their annual flu vaccine, if they’re over age 2
• keep your child off school or nursery if they’re unwell, and encourage lots of rest
• support their natural immune system with a diet rich in fruits and veggies, and consider a kid-friendly vitamin D supplement and probiotic, for targeted support
• keep strep A and scarlet fever info to hand – on your phone or a print-out – for quick reference

We know it’s much easier-said-than-done, to keep kids off school and nursery or childcare, as working, busy parents and carers. But a day or two off to make a full recovery can save much lengthier periods at home, if a sore throat and virus morphs into something more serious. 

Worried about your child? Call 999 or go to A&E now if any of these apply: 

• your child is having difficulty breathing
• there are long pauses (more than 10 seconds) when your child breathes
• your child’s skin, tongue or lips are blue
• your child feels very cold or clammy to touch
• your child is difficult to wake or to keep awake
• your child has severe pains in their arms, legs neck or back
• your child has a very painful, red area of skin, especially if it is getting bigger quickly
• your baby is under one month old and has a temperature of 38°C or above

Read next: Strep A symptoms in children – how worried should I be?