By:  Karen Sullen

You're bathing your baby and notice a bright red rash oh his back.  You've never seen it before and aren't quite sure what it is.  Do you wait and see if it clears up on its own or grab your baby out of the bath water and head straight to the emergency room?  Because most parents aren't sure what to do, it is common to err on the side of safety and go to the emergency room.  However, most skin rashes for children are rarely urgent and can be handled during an appointment to your pediatrician's office.  The trick is identifying what type of rash you're looking at.  Because children often come in contact with several known and unknown irritants that could cause a rash, let's take a look at a few of them.  It could mean the difference between a good night's sleep or pulling an all-nighter at the hospital.  

Petechiae or Purpura
Urgent:  Caused by ruptured blood vessels under the skin, these are probably the only rashes that would require a trip to the emergency room because.  Petechiae appear as tiny, red spots that look as if someone used a fine-tip red ink pen to put little dots on the skin.  Purpura is similar, but the spots are larger and can be more purple or blue in color.  You can distinguish these spots from other rashes because:

•    They don't blanch when you press on them. Many other kinds of spots will turn white or skin-colored for 1-2 seconds when pressed and then turn red again. Petechiae and purpura will stay red or purple. 
•    They are completely flat. The skin is not raised because the rash occurs under the skin. 

However, there is one situation where petechiae are not urgent. If your child has a very bad cough or is vomiting, the pressure in the head can cause little blood vessels in the skin of the face and neck to rupture and form petechiae. These petechiae are okay and shouldn't overly concern you.  But, if they are found anywhere else on the body besides the face and neck, this could be a sign of a serious infection or bleeding problem. 

Not Urgent (but can be):  These welts seem to appear out of nowhere, and can spread rapidly. They are most common on the trunk (chest, tummy or back), but can also be on the extremities, and sometimes on the face.  Making them easily identifiable, each welt will often come and go over a period of 10-15 minutes or as long as a few hours, popping up in different places on the body.  The shape and size of the welts can vary, even appearing clustered and overlapping.  Typically itchy, they are caused by an allergic reaction or are associated with a normal illness, such as a cold or fever.  Because hives are the result of an allergic reaction, if your child develops throat tightness, wheezing, breathing difficulty, or persistent vomiting, a trip to the ER may be warranted.

Heat rash 
Not Urgent:  After being exposed to high temperatures, tiny red pimples, bumps, or spots can appear on the back of the neck, lower back, and sometimes the entire trunk. Resulting from a mix of sweat, heat and clothing, the rash is commonly treated by cooling your baby off, airing out the area, or applying a cool washcloth to reduce baby's temperature.

Not Urgent:  A common cause of fever and rash in infants and young children, this skin irritation is caused by a virus and starts out with moderate-to-high fevers with no other symptoms.  On the fourth day, the fever breaks, and a rash develops.  However, no other symptoms remain.  Roseola can be identified by red spots and bumps starting on the upper back and neck, spreading down the trunk and into the arms and legs.  It sometimes appears like a lace imprint or pattern on the skin.

Chicken pox 
Not Urgent:  Often mistaken for insect bites, you might only see a few red spots or bumps initially, accompanied by a fever.  Each day, the virus causes new bumps to appear, and the older bumps will turn into blisters.  By the fourth day, the original blisters will start to crust over.  The appearance of new bumps begins to taper off by the fifth day, and by the 7th day, most or all of the blisters will be crusted over. The fever can last for five days, but once the fever is gone and all the blisters are crusted over, your child is no longer contagious.  Because it is difficult to properly identify chickenpox in the first two days, it may be best to quarantine your child and monitor the bumps until day three.  If the bumps change into blisters within 24-48 hours, consider it chicken pox.

Not Urgent:  This appears as an itchy, red, raised ring where the skin almost appears normal in the middle.  Caused by a fungus, any number of these rings can present themselves over the body.  Ringworms are transmitted from other infected animals or people and can sometimes be accompanied by a general rash of fine, red bumps appearing elsewhere on the body as an allergic reaction to the fungus that causes the rash.  The good thing is that, in most cases, ringworms can be treated with over-the-counter medications and should clear up in a few weeks. 

These skin irritations, along with diaper rash, are some of the more common skin rashes your child may encounter.  In most cases, if the child is still behaving normally and no other symptoms are present, you will probably only need to schedule an appointment with the doctor.  But as always, when it comes to your child's health, consult your physician with questions or concerns.