A Parent's Guide to Paronychia

As a pediatrician and a mom, I've seen my fair share of tiny fingers with red, swollen nail beds. That painful condition has a name: paronychia. It's one of the most common hand infections in children, and while usually not serious, it certainly deserves your attention.

Today, I want to walk you through everything you need to know about paronychia - what it is, how to spot it, what you can do at home, and when it's time to come see me or another healthcare provider.

what is paronychia?

Paronychia is an infection of the skin around the fingernail or toenail. It typically occurs when bacteria (or sometimes fungi) enter through tiny cuts or breaks in the skin around the nail.

In children, paronychia often happens due to:

  • Nail biting

  • Finger sucking

  • Hangnails that get pulled

  • Picking at the skin around nails

  • Manicures that cut too close to the nail bed

  • Ingrown nails

what to look for

The signs of paronychia are usually pretty noticeable:

  • Redness and swelling around the nail

  • Pain or tenderness when the area is touched

  • Warmth in the affected area

  • A small collection of pus (you might see a yellowish color under the skin)

  • In some cases, the nail may appear distorted or discolored

Most children will let you know something's wrong - they'll be reluctant to use the affected finger or toe because it hurts!

what to do

For mild cases, there's quite a bit you can do at home:

  1. Warm soaks or compresses are your best friend. Soak the affected finger or toe in warm (not hot) water 3-4 times a day for about 15 minutes. For wiggly kids, a warm, wet washcloth wrapped around the finger works too.

  2. Gently dry the area thoroughly after soaking.

  3. Keep the area clean by washing with mild soap and water.

  4. Cut nails straight across and not too short to prevent future episodes. Avoid rounding the corners of nails, which can lead to ingrown nails.

  5. Discourage nail biting and finger sucking as much as possible (I know, easier said than done).

  6. Keep the area uncovered unless your child is playing in dirt or sand.

When home treatment isn’t enough…

If the paronychia doesn't improve with home care after 1-2 days, or if it's severe from the start, medical treatment may include:

  • Topical antibiotics like mupirocin (Bactroban) for mild cases

  • Oral antibiotics for more severe infections. We typically prescribe cephalexin (Keflex) as our first choice. For children with allergies or other risk factors, clindamycin may be used instead.

  • Incision and drainage for larger abscesses. This involves making a tiny opening to allow pus to drain out. While this sounds scary, it provides immediate relief and is sometimes necessary for healing.

when to seek help

Call your pediatrician if you notice:

  • Increasing redness, swelling, pain, or warmth after 24-48 hours of home treatment

  • Pus or drainage that's increasing

  • Red streaks extending from the infected area up the finger or hand

  • Fever

  • Multiple nails or fingers/toes affected

  • Your child has diabetes or is immunocompromised

  • The paronychia is on the thumb in a child under 1 year old (this can sometimes be more serious)

Come to the emergency room if:

  • The infection appears to be spreading rapidly

  • Your child has severe pain

  • There's significant swelling beyond the nail area

  • Your child develops a fever over 101°F (or 100.4F if under 3 months old) along with the infection

prevention tips

The best way to deal with paronychia is to prevent it in the first place:

  • Keep nails clean and trimmed straight across

  • Moisturize hands and feet to prevent skin cracks around nails

  • Discourage nail biting and finger sucking

  • Avoid cutting cuticles or pushing them back too aggressively

  • Wear waterproof gloves for prolonged water exposure (for older kids helping with dishes or cleaning)

  • Ensure proper foot hygiene, especially for active children who may get sweaty feet

and just remember…

Paronychia is usually more uncomfortable than dangerous, and with proper care, most cases resolve without complications. Trust your instincts as a parent - if something doesn't seem right or your child is in significant distress, don't hesitate to reach out to your pediatrician.

Sending you a big hug,

Anjuli

Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.

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