From the Guidelines
Measles in toddlers typically begins with high fever, cough, runny nose, and red, watery eyes, and can progress to severe complications such as pneumonia, encephalitis, and even death, especially in infants and young children. The incubation period of measles averages 10-12 days from exposure to prodrome and 14 days from exposure to rash, with a range of 7-18 days 1. The disease can be severe and is most frequently complicated by diarrhea, middle ear infection, or bronchopneumonia.
Key Symptoms and Progression
- High fever, cough, runny nose, and red, watery eyes are the initial symptoms, appearing 7-14 days after infection and lasting for 2-4 days before the characteristic rash develops.
- The rash starts as flat red spots on the face, particularly behind the ears and along the hairline, then spreads downward to the neck, trunk, arms, legs, and feet.
- Small white spots called Koplik spots may appear inside the mouth 2-3 days before the rash.
- As measles progresses, the fever can spike to 104°F or higher, and the child may become increasingly irritable and lethargic.
Prevention and Treatment
- The MMR vaccine, given at 12-15 months and again at 4-6 years, is the most effective prevention method, providing about 97% protection after two doses.
- There is no specific treatment for measles itself, but acetaminophen or ibuprofen can be given for fever (never aspirin due to risk of Reye's syndrome).
- Keeping the child hydrated is crucial, and isolation is necessary until the rash has been present for at least 4 days.
Special Considerations
- Infants under 12 months are at higher risk for severe disease, and measles vaccination of infants as young as 6 months may be undertaken as an outbreak control measure 1.
- Children vaccinated with measles or MMR vaccine before the first birthday should be revaccinated at age 12-15 months and again before entering school.
From the Research
Symptoms of Measles in Toddlers
- Fever combined with one of the following: cough, coryza, conjunctivitis are the first manifestations of the disease 2, 3
- Koplik's spots may also appear on the buccal mucosa providing an opportunity to set the diagnosis even before the emergence of rash 2
- Rash typically appears 3-4 days after the onset of fever, initially on the face and behind the ears, and its appearance is associated with the peak of the symptoms 2
- Maculopapular rash, and at least one of cough, coryza, or conjunctivitis 3
Progression of Measles
- Measles affects multiple systems, including the respiratory system, with pneumonia being one of the most lethal complications 2
- Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea 3
- Neurological complications are uncommon but serious, and can occur during or soon after the acute disease (eg, acute disseminated encephalomyelitis) or months or even years later (eg, measles inclusion body encephalitis and subacute sclerosing panencephalitis) 3
- Most deaths due to measles are caused by pneumonia, diarrhea, or neurological complications in young children, severely malnourished or immunocompromised individuals, and pregnant women 4