To classify a child as having measles, the child with fever must have a generalised rash and one of the following signs: cough, runny nose or red eyes. Assess a child with fever to see if there are signs suggesting measles. Look for a generalised rash and one of the following signs: Cough, runny nose or red eyes, generalised rash.

In measles, a red rash begins behind the ears and on the neck. It spreads to the face first and then over the next 24 hours, the rash spreads to the rest of the body, arms and legs. After four to five days, the rash starts to fade, and the skin may peel, does not have blisters or pustules. The rash does not itch. Differentiate the other common childhood rashes such as chicken pox, scabies or heat rash. Refer your communicable disease module for the clinical features.

If the child has measles now or within the last three months:

• Look for mouth ulcers. Are they deep and extensive?.
• Look for pus draining from the eye.
• Look for clouding of the cornea.

LOOK to see if the child has mouth or eye complications.

LOOK for mouth ulcers. Are they deep and extensive?.

• Mouth ulcers are common complications of measles which interfere with the feeding of a sick child. Look for mouth ulcers in every child with measles and determine whether they are deep and extensive.
  
• The mouth ulcers should be distinguished from Koplik spots. Koplik spots occur inside the cheek during the early stages of measles infection. They are small irregular bright spots with a white centre. They do not interfere with feeding.
  

LOOK for pus draining from the eye.

• Pus draining from the eye is a sign of conjunctivitis. If you do not see pus draining from the eye, look for pus on the eyelids. Often the pus forms a crust when the child is sleeping and seals the eye shut.
  
• It can be gently opened with clean hands. Wash your hands before and after examining the eye of any child with pus draining from the eye.
  

LOOK for clouding of the cornea.

• Look carefully for corneal clouding in every child with measles. The corneal clouding may be due to vitamin A deficiency which has been made worse by measles. If the corneal clouding is not treated, the cornea can ulcerate and cause blindness.
  
• A child with clouding of the cornea needs urgent referral and treatment with vitamin A.