Paronychia in Babies and Children: How to Treat It

Paronychia in babies and children are usually caused by the habit of putting their fingers in their mouths. Learn how to manage them.
Paronychia in Babies and Children: How to Treat It

Last update: 07 July, 2022

Paronychia in babies and children is an inflammatory disorder of the nail folds of both fingers and toes, which appear in the form of redness, tenderness, and swelling. Its scientific name is paronychia.

Although it occurs more frequently in adults, it’s also common in children and infants. Therefore, it’s important to know how to manage these infections.

What causes paronychia in infants and children?

The oral trauma caused by sucking the fingers predisposes infants and children to develop infections by germs that are very different from those of adults. Contamination of the lesion with saliva can lead to a variety of conditions and even to the generation of abscesses within the nail fold.

According to a study published in the American Journal of Surgery, in the pediatric population, paronychia is caused by mixed anaerobic and aerobic bacteria in 46% of cases. And these usually originate from the oral cavity.

A toddler with his fingers in his mouth.
The habit of putting hands in the mouth increases the likelihood of developing paronychia. Especially if the child bites their fingers or nails.

Therefore, babies with finger-sucking behaviors to calm down may have a higher risk of developing nail beds.

Signs and symptoms of paronychia in babies and children

Paronychia in babies and children isn’t a common condition, however, it’s a reason for medical consultation within the first days due to pain.

In short, paronychia is an inflammatory process characterized by the following local symptomatology:

  • Redness
  • Swelling
  • Increased sensitivity
  • Pain

Therapeutic options for paronychia in babies and children

Paronychia usually disappears after a few days. If this isn’t the case, there are different therapeutic options to treat it. In fact, the way it’s managed depends on the severity of the condition, the duration, and the age of the affected person.

Hygienic measures

The initial treatment is warm water and salt baths on the affected fingers. In some cases, the use of antiseptic solutions (povidone iodine or chlorhexidine) or 1% Burow’s solution is also recommended.

Continuous brine baths help to reduce inflammation and pain in the affected area. It’s best to practice them several times a day, for at least 10 to 15 minutes. In general, they’re usually quite effective.

In turn, it’s not a good idea to cut the nails in a rounded shape, nor to trim the cuticles or the skin. In fact, poor nail trimming is one of the most frequent causes of paronychia.

Oral antibiotic treatment

Oral medication treatment accompanies hygienic measures. Antibiotics that cover common skin germs (such as cephalexin) or broaden the spectrum for bacteria from the child’s mouth (such as trimethoprim-sulfamethoxazole) are recommended.

In most cases, oral antibiotics should be prescribed for 7 to 10 days. Follow your health care provider’s instructions and don’t stop taking the medication even if your child reports feeling better.

Topical medications

If brine baths fail to control inflammation, topical corticosteroids may be necessary. These help to soothe the pain and reduce inflammation. Several topical antibiotics (such as mupirocin, fusidic acid, and bacitracin) even include them in their presentation as triple antibiotic ointments.

The idea is to apply the antibiotic cream 4 to 5 times a day on the affected areas, on freshly moisturized skin. There are different presentations such as the following:

  • Ointment
  • Cream
  • Lotion
  • Gel

Ointments tend to remain for longer periods on the area to be treated compared to creams.

Surgical treatment

Although the initial therapy is hygienic measures and topical or oral medications, incision and drainage in the area is a useful adjunct to healing.

A woman cutting a child's nails.
Nails should be cut straight across and after bathing in order to avoid ingrown nails.

This procedure is reserved for abscesses, in which it’s pertinent to evacuate the pus and relieve the pressure of inflammation in the affected area. It’s performed with a scalpel and local anesthesia and doesn’t necessarily require hospitalization.

In addition, treatment includes trimming and removal of the ingrown spicule to allow normal nail growth.

Differential diagnosis of paronychia

The differential diagnosis of paronychia can include different skin and soft tissue diseases. Some of them are the following:

  • Cellulitis: a superficial infection that presents with redness and swelling, but without tissue fluctuation due to the presence of pus or fluids.
  • Herpetic whitlow: is a viral infection of the finger caused by the herpes simplex virus (HSV).
  • Onychomycosis is a fungal infection that causes yellowish-whitish discoloration.
  • Nail psoriasis: thickened nails, with pitting areas, ridges, and irregular contours.
  • Squamous cell carcinoma: in most cases, it occurs in the skin, but also occurs in the nail bed.

Paronychia in babies and children

Paronychia in babies and children usually has a good prognosis, and in most cases, resolves within a few days.

There are countless home remedies that are shared on social networks, but self-medication in children isn’t recommended, even in cases of paronychia. If in doubt, contact your doctor.

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