Measles in kids usually starts with a high fever, a cough, a runny nose and red, watery eyes. A few days later, tiny white spots can appear inside the cheeks, and then a red rash begins on the face and spreads down the body.
Those early signs look a lot like flu, so the order they appear in matters more than any single symptom. Below you will find the timeline, the illnesses it is confused with, and the danger signs that mean your child needs urgent care.
Case counts change quickly, so check your state or local health department for the numbers in your area. The symptoms to watch for are the same either way. A 2021 study in Social science & medicine, indexed on PubMed, analyzed news coverage of two measles outbreaks, one in California at Disneyland and one among the Amish in Ohio.
What are the first measles symptoms in kids?
UNICEF’s parent guide says the early symptoms appear 7 to 14 days after exposure to the measles virus. They are a high fever, a cough, a runny nose, and red, watery eyes. UNICEF also notes that these early symptoms are vague and easily mistaken for seasonal flu.
The sign that most separates measles from a cold is Koplik spots. Northside Pediatrics describes them as tiny white specks on the lining of the mouth, inside the cheeks, that appear one to two days before the rash. They can be hard to see. MDPremier’s article on early measles symptoms says they look like tiny grains of white sand on a red background. MDPremier’s article says the illness starts about seven to fourteen days after exposure, citing the CDC’s measles signs and symptoms page.
What does the measles rash look like, and when does it start?
March of Dimes says the rash usually comes two to five days after the first symptoms. It starts as flat red spots on the face and spreads down the body to the arms, legs and feet, and small bumps may appear on top of the flat spots. UNICEF describes small, raised red or brownish spots that may merge into larger, blotchy areas and usually do not itch. Here is the timeline, measured from the first symptoms.
| Stage | When it happens | What you may see |
|---|---|---|
| Early symptoms | 7 to 14 days after exposure (UNICEF) | High fever, cough, runny nose, red and watery eyes |
| Koplik spots | 1 to 2 days before the rash (Northside Pediatrics) | Tiny white specks inside the cheeks |
| Rash starts | 2 to 5 days after first symptoms (March of Dimes); 3 to 5 days (UNICEF) | Flat red spots, usually on the face and neck |
| Rash spreads | Over about 3 days (UNICEF, Northside Pediatrics) | Down the arms, trunk, legs and feet; spots may merge |
| Rash fades | About 5 to 6 days (UNICEF); usually gone by 7 days (Northside Pediatrics) | Usually does not itch (UNICEF) |
The guides differ on where the rash begins. UNICEF says it usually starts on the face and neck, and MDPremier says it often starts at the hairline or behind the ears. Either way, the pattern to report is a rash that moves from the head downward over several days.
How long does measles last in kids?
The rash itself is short. UNICEF says it lasts around 5 to 6 days, and Northside Pediatrics says it is usually gone by 7 days. The whole illness lasts longer. March of Dimes says measles can last for several weeks, so plan for a slow recovery rather than a few days in bed.
What are the worst days of measles?
MDPremier says the fever often reaches its highest point as the rash appears, and March of Dimes says fever may spike to more than 104 F. For when to seek care, see the danger-sign table below.
Which age is worst for measles?
Babies and young children face the highest risk. UNICEF says measles is especially dangerous for babies under one year old and for children under five who have not been vaccinated. March of Dimes reports that about 1 in 3 children under 5 who get measles need treatment in a hospital.
What are the measles symptoms in babies?
UNICEF says babies under 12 months are more likely to become seriously ill or die from measles, because in most countries they are not vaccinated until after their first birthday. Until a baby can be vaccinated, keep them away from anyone with a cough, fever, runny nose, red eyes or a rash, wash your hands often, and keep the home well ventilated. If you are breastfeeding, keep going. In some countries, babies can be vaccinated from 6 months of age, so ask your doctor what applies where you live.
What are the measles symptoms in adults?
Adults can get measles too, especially if they were never vaccinated or their protection has faded over time. UNICEF says adults can make up 10 to 20 percent of cases during outbreaks. For the adult pattern, read measles symptoms in adults.
What is commonly mistaken for measles?
Early measles looks like flu. Once the rash appears, other childhood rashes can look similar. MDPremier names the three C’s of measles: cough, coryza (a very runny nose) and conjunctivitis (red, watery or inflamed eyes). If a rash comes without a fever or those signs, MDPremier says measles is highly unlikely.
| Condition | How it differs from measles (MDPremier) |
|---|---|
| Roseola | High fever for three to five days, with the rash appearing only after the fever is gone. The rash starts on the chest or back and skips the face. |
| Fifth disease | A bright red rash on the cheeks, often followed by a lacy pink rash on the body. Children usually do not look as ill as children with measles. |
| Heat rash | Tiny red bumps or clear blisters where sweat is trapped, often on the neck, armpits or diaper area. It is usually prickly or itchy and rarely causes a fever. |
| Contact dermatitis | An itchy rash where the skin touched a trigger, such as a detergent or a plant. It does not spread across the body and is not accompanied by a cough or runny nose. |
A child with a rash and no fever or cough is a different case from a child with measles-type symptoms. When you are not sure which one you are seeing, let the doctor decide.
What are the danger signs of measles?
Northside Pediatrics lists the urgent signs in its measles guide. Use this table to decide how fast to act. UNICEF adds one general rule: if symptoms start getting worse, go to the hospital immediately.
| What you see | What to do (per Northside Pediatrics) |
|---|---|
| Severe trouble breathing: struggling for each breath, or can barely speak or cry | Call 911 now |
| Difficult to wake, or confused when awake | Go to the ER now |
| Trouble breathing that is not severe, a severe headache, or a child who looks or acts very sick | Call the doctor or seek care now |
| Symptoms that keep getting worse | Go to the hospital immediately (UNICEF) |
Measles can also cause serious complications. March of Dimes lists the following figures for children who get measles.
| Complication | How often, per March of Dimes |
|---|---|
| Pneumonia | As many as 1 in 20 children with measles (5 percent) |
| Ear infection | About 1 in 10 children with measles (10 percent) |
| Encephalitis (brain swelling) | About 1 in 1,000 children with measles |
| Subacute sclerosing panencephalitis (SSPE) | A rare, deadly disease that can develop 7 to 10 years after measles; the chances may be higher if measles happens before 2 years of age |
UNICEF also lists severe diarrhea and dehydration, serious breathing problems, blindness and deafness. For a sudden change in hearing in one ear, which is a separate question, see sudden hearing loss in one ear.
How do you confirm measles?
The pattern to bring to the doctor is fever, cough, runny nose and red eyes, followed by a rash that spreads from the face down the body. MDPremier advises calling the office before you arrive so staff can keep other patients out of the waiting room. Clear photos of the rash and a log of your child’s temperature can help the medical team, according to the same article. Your child’s doctor decides whether testing is needed.
Is measles contagious?
Yes. UNICEF calls measles the most contagious disease in the world. March of Dimes says the virus spreads when an infected person breathes, coughs or sneezes, and that it can live up to 2 hours on surfaces or in the air. It also says up to 9 in 10 people who are not immune will get sick after close contact. A child can pass it on from 4 days before the rash to 4 days after it appears, according to March of Dimes and Northside Pediatrics. Because spread can start before the rash shows, keep a sick child home and away from other people until a doctor has examined them.
Do you still get measles if you are vaccinated?
Vaccination protects most children, but the figures vary by source. March of Dimes says two doses of the MMR vaccine are 97 percent effective at preventing measles. Northside Pediatrics says one dose gives 95 percent protection and two doses give 99 percent, and that a fully vaccinated child who still gets measles would have much milder symptoms. UNICEF says children need two doses for full protection. If your child has had one dose, or you are not sure, ask the doctor about the next dose.
If your child was around someone with measles, Northside Pediatrics advises contacting a doctor within 24 hours if a child 12 months or older who has never had MMR or measles was exposed in the last 72 hours, or if a child under 12 months, or a high-risk child, was exposed in the last 6 days, because the vaccine can protect. For an unvaccinated child with a known exposure, it says to keep the child home until 21 days have passed since the exposure, with no visitors and no school.
Can I treat my child’s measles at home?
There is no cure or specific treatment for measles, according to March of Dimes. Home care focuses on comfort and fluids. UNICEF suggests helping your child rest, keeping the room quiet and dim, and encouraging plenty of fluids. If there is diarrhea or vomiting, oral rehydration salts can help replace lost fluids. Keep offering nutritious food, and keep breastfeeding if you are. For fever, March of Dimes says to ask your child’s healthcare provider whether infant’s or children’s acetaminophen or ibuprofen is right for them. UNICEF says the World Health Organization recommends that children with measles receive two doses of vitamin A, which your doctor will provide. Ask your child’s doctor about any foods to avoid before you change what your child eats.
What is not known yet?
If there is a measles outbreak in your area, your state or local health department can tell you whether your family is at increased risk. Early symptoms also do not show how sick a child will become, which is why the warning signs matter more than the first fever. For U.S. guidance, the CDC measles signs and symptoms page is the place to check current information. If your child shows any danger sign in the table above, go to care now rather than waiting to see how the illness develops.
Clinical Research Explained is an editorial publication, and this page contains no product or seller links.
By the Clinical Research Explained Editorial Team