Slap Cheek 2022

 

Slap Cheek

Slap cheek is one of those illnesses that seems to come around a couple of times a year. Dr. Ted mentioned that he has been seeing a lot of it this week, so it is worth knowing about it. This virus is also known as Fifth disease. It got that name back in the 1880s. At the time, childhood diseases that caused rashes were assigned a number. This was number 5 out of 6. Others on that list included measles and scarlet fever. It is also known as Erythema Infectiosum or Parvovirus B19. I just call it Slap Cheek. Just like Hand Foot Mouth (another of those viruses that make parents question why they signed up for this), Slap Cheek is a contagious rite of passage. Most people get it while they are still children and thus have immunity as adults. The majority of cases happen in kids between 4-14 years of age. It spreads through respiratory secretions, but can also be carried through infected blood. Unless you had a memorable case of it, most people don't actually know whether they have had it or not. You can check with the grandma or grandpa, but I bet they don’t remember either. The symptoms may have been mild enough that no one paid much attention. This illness can be quite variable. Some kids don't seem too impaired while others are miserable. The mild cases can present with a child who has a red chapped cheek for a day or so, and that's it!  The common denominator (hence the name) is one or both cheeks usually appear very red and irritated. Red cheeks aren't definitive. Some kids look flushed when they have a fever no matter what. This diagnosis often has some guessing involved. For most patients, the red cheeks are followed by a lacy, mottled rash that works its way up and down the body. This rash tends to cover the arms and legs more than the trunk. Of course there are exceptions; some kids don't read the textbooks and present in their own unique way. People with more moderate cases often have high fevers. Kids tend to be pretty fussy. These fevers can come and go over a period of several weeks.  In more severe cases it can cause painful or swollen joints (polyarhropathy syndrome). This is much more common in older kids or adults. In rare cases, it can also cause the body to temporarily stop making new red blood cells. This can lead to anemia. People with sickle cell disease, other types of long lasting anemia, or weakened immune systems are more at risk for these complications There is no real treatment for Slap Cheek. Western medicine doesn't have any magic wand for this. What you will likely get out of a visit to the doctor is assurance that there is nothing more serious going on. Four out of five of my patients with high fevers might have slap cheek, but that fifth might be the one with strep throat. In general, if you have a miserable kid with a fever that doesn’t respond to medication, it is usually worth having them checked out.  Frankly, the issue about slap cheek that is of the most concern, is that it can be dangerous to a fetus.  If a woman is infected in the early stages of pregnancy there is an increased chance of miscarriage. If you have a toddler with Slap Cheek, try to minimize exposure to anyone who is expecting. If you are pregnant and may have been exposed, take a deep breath and remember that most women had this as a child and are therefore not at risk. Just to be on the safe side, talk to your OB about getting a blood test to check your immunity. It is not reasonable to try to isolate yourself from your own child. The fact is, they were likely contagious before you had a diagnosis. The incubation period is thought to be about 4-21 days after the exposure. In other words, if you come into your doctor’s office and walk out with a red cheek, you didn't get it there; that would be way too soon. The kids are most contagious at the very beginning of the illness when the main symptom is probably simple fussiness. The cheeks might be red, but you reasonably figure that this could simply be caused by being a little warm. By the time the rash is in full throttle they are probably not very contagious anymore. Often patients have some congestion as part of the package. Treatment is symptomatic. Treat the fevers as needed with Tylenol/Ibuprofen and tepid baths. Make sure your child gets plenty of fluids and rest as needed. My best daycare, camp, and school guidelines are to keep a child home if they are fussy or have a fever. If you have a happy child with a red cheek, it seems unreasonable to expect you to stay home from work. Chances are, once one of the kids in daycare shows up with it, everyone has already been exposed.