Pediatric Infectious Diseases

Impetigo in Children

What is impetigo in children?

Impetigo is a skin infection. When it affects just the surface, it’s called superficial impetigo. Impetigo can also affect deeper parts of the skin. This is called ecthyma. It may occur on healthy skin. Or it may occur where the skin was injured by a cut, scrape, or insect bite.

Impetigo is most common in children from ages 2 to 5. It is contagious. This means it’s easily passed from one person to another. It can be spread around a household. Children can infect other family members and can reinfect themselves.

What causes impetigo in a child?

Impetigo is caused by bacteria. The bacteria that can cause it include:

Group A beta-hemolytic Streptococcus
Staphylococcus aureus

Which children are at risk for impetigo?

Impetigo is more common in children, but adults may also have the infection. A child is more likely to get impetigo if they:

Have close contact with others with impetigo
Don't keep clean (poor hygiene)
Are in warm, moist (humid) air
Have other skin conditions, such as scabies or eczema

What are the symptoms of impetigo in a child?

Symptoms can occur a bit differently in each child. They also vary depending on which bacteria caused it. Symptoms can include:

Red bumps
Sores that are filled with fluid, draining fluid, or crusted over (this often results in the classic "honey-colored crust" appearance)
Areas that are red, swollen, and may itch
Swelling of nearby lymph glands (nodes)

The bumps or sores can be painful and appear anywhere on the body. But they are most common on the face, arms, and legs.

The symptoms of impetigo can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is impetigo diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. A sample of the pus from the sores may be sent to a lab. This is called a culture. It’s done to see what type of bacteria caused the infection. It can help the healthcare provider decide the best antibiotic for treatment.

How is impetigo treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

Prescription antibiotic cream or ointment. This is most often done for mild impetigo.
Antibiotic pills or liquid by mouth (oral). This is most often advised if your child has several areas of impetigo or ecthyma. It may also be advised if more than one person in a household has impetigo.
Cleaning and bandaging. You will need to gently wash affected areas of your child’s skin with mild soap and water. Cover areas that are draining fluid. Make sure to scrub your hands for at least 20 seconds before and after caring for your child’s impetigo. Put old bandages in a sealed bag and throw them away.

What are possible complications of impetigo in a child?

Possible complications of impetigo can include:

The infection gets worse or spreads
Scarring, which is more common with ecthyma

Impetigo caused by beta-hemolytic strep bacteria can occasionally cause:

Kidney damage (poststreptococcal glomerulonephritis)
Fever, joint, and other problems (rheumatic fever)

What can I do to prevent impetigo in my child?

You can help to prevent impetigo and prevent it from spreading to others. The following may help:

Keep your child out of daycare or school for 48 hours after starting antibiotic treatment. If your child is improving with treatment, they can return after 48 hours. Cover any draining sores with bandages.
Make sure your child and everyone else in your household washes their hands often and well. This means using soap and water and scrubbing for at least 20 seconds.
Don't share personal items, such as towels or washcloths.
Have everyone in the household use their own towels for drying hands and for after bathing. Don't share towels.
Keep your child's fingernails short. This can help prevent your child scratching and spreading the infection.
Teach everyone in the family when and how to correctly wash their hands.

When should I call my child's healthcare provider?

If your child is being treated for impetigo, contact your provider if their symptoms don't improve or get worse. Call the healthcare provider if your child has a skin infection after being in contact with anyone who has impetigo. Keep your child away from others until a diagnosis has been made.

Key points about impetigo in children

Impetigo is an infection that affects the skin. It’s caused by bacteria and can spread from one person to another.
It causes skin sores. The sores may be red and painful, and contain fluid called pus. They may drain and crust.
Impetigo is often treated with antibiotic cream, ointment, pills, or liquid.
Keeping the skin clean may help to prevent the spread of impetigo. It is very important to scrub your hands with soap and warm water for at least 20 seconds before and after caring for your child.
Impetigo can spread in a household. Don't share towels, washcloths, eating utensils or other personal items.
Your child can return to daycare or school 48 hours after starting antibiotic treatment as long as there are signs of improvement.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.