Slapped cheek or Fifth syndrome


“Slapped cheek” is a viral infection caused by a virus called parvovirus B19. It is also called ‘fifth disease’ or erytherma infectiosum.

Slapped cheek usually affects children between the ages of four and 10 but can happen at any age, even in adulthood. Most infections do not have any symptoms. Six out of ten people in the population have had the virus by the time they are adults. It is not life threatening and complications are rare.

Signs and symptoms

Symptoms can take between 4 to 14 days to appear after getting the virus.

The symptoms are usually so mild that many people don’t even know they have had the virus.

The first symptoms can include fever, headache, stomach upsets, aches and pains. This is the time when the virus can be spread to others, mainly through saliva.

A bright red rash appears on the cheeks three to seven days after getting the virus. The cheeks look like they have been slapped, hence the name Slapped Cheek.

Your child may also have a different rash on the chest, back, arms and legs.The infection looks like a pink lace pattern on the skin. The rash can come and go for several weeks, especially if the skin is exposed to sunlight or after exercise.


Slapped cheek is caused by a virus called the human parvovirus B19. This is different from the parvovirus that is seen in cats and dogs.

How is it spread?

Slapped cheek is spread by touching or breathing in the coughed or sneezed fluid drops from an infected person.


Most children do not need any treatment except for resting and allowing the body to fight the infection. Fever may be controlled with paracetamol. Antibiotics will not work because slapped cheek is caused by a virus.

At home care

Once you can see the rash on the face, children cannot spread the infection to others. Children can keep going to school or daycare.


There is usually no specific follow up needed. A few children may develop swelling and pain in the joint of their hands and feet. If this happens they should see a doctor for advice on how to treat these symptoms.

Special consideration

You should speak to your child’s medical team if you suspect your child has slapped cheek and your child is taking long term steroids or is immune-compromised (ie on chemotherapy or has had an organ transplant).

Contact the medical team or your family doctor for advice if your child has sickle cell anaemia or severe anaemia (low level of red blood cells in the blood).

If you are pregnant and exposed to someone with slapped cheek, ask your family doctor to test if you had human parvovirus B19 in the past by performing a parvovirus IgG serology test. Remember the person with slapped cheek disease is infectious two weeks before the rash appears. If you have already had human parvovirus B19 then there are no concerns for your unborn baby. If you have not, your unborn baby can get a type of anaemia (low level of red blood cells in the blood).

This is rarely serious and usually resolves itself. Your obstetrician can provide more advice. The virus does not cause any other problems for the baby.

Key points to remember

Slapped cheek is caused by a virus and antibiotics will not work to treat it.

Symptoms can vary between children but many won’t even know they have had it because the infection shows up with very few symptoms.

Once there is a rash on the face, the child with the rash is not infectious and cannot spread the infection to others. They can go to school or play centre as usual.